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Sample forms for use by Class A
Child Day Care Centers
These are sample forms provided by the Licensing Bureau that may be used by Class A Day Care Centers. The numbers in parentheses refer to the section of the licensing regulations that covers the topic.
- As Needed Medication Authorization Form (5321.B; 5321.C; 5321.G)
- Authorization for the Application of Topical Products (5321.I)
- Before and After School Children´s Daily Attendance Log (5305.H)
- Bottle Authorization (5319.H)
- Daily Attendance for Children (5305.H)
- Daily Observation Report (5321.J)
- Daily Transportation Attendance Record (5335.E & F)
- Field Trip Log and Permission Form (5333.A; 5333.C; 5333.F)
- Field Trip Permission Form (5333.A)
- Field Trip Transportation Log (5333.C; 5333.F)
- Illness/Unusual Behavior Report Form (5321.L)
- Incident/Accident/Injury Report Form (5321.K)
- Infant Daily Report (5319.J)
- Job Description (5311.A.3)
- Master Card (5307.A.1-3)
- Master Transportation List (5335.D)
- Medication Authorization Form (5321.B; 5321.G)
- Menu Plan Form (5319.A)
- Monthly Fire Drill (5327.O)
- Non-Vehicular Excursion Authorization (5329.A)
- Non-Vehicular Excursion Record (5329.B)
- Orientation Training Verification (5312.A; 5312.C)
- Parent Administering Medication at Center (5321.H)
- Parental Awareness of Recordings (5307.D)
- Permission to Release Photograph (5307.C)
- Physical Examination (5311.A.4)
- Quarterly Staff Meeting/Session (5312.B)
- Reference Check Documentation (5311.A.2)
- Regularly Scheduled Transportation Authorization Form (5307.A.4)
- Sign-In Log for Extracurricular Personnel and Student Trainees (5311.B.2; 5311.C.3)
- Staff Daily Attendance Log (5305.I)
- Staff Information Record (5311.A.1)
- Student Trainee Form (5311.C.1; 5311.C.2)
- Visual Check of Center (5327.P)
- Water Activities Permission Form (5313.A)
