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Community and Family Health Division


Provisional Child Care HOME License:

A child care home refers to a facility located in a residence providing care to no more than eight children. When applying
for a Child Care Provisional Home License, the applicant should refer to the Introduction to the Provisional Child Care Licensing Process and any other additional information.  Please read and follow the instructions carefully to help guide you to a successful application submittal. All forms are located below.

  1. Introduction to the Provisional Child Care Licensing Process
  2. Provisional Application Checklist – H
  3. CCL01 Application for Provisional Child Care License
  4. CCL02 Owner Permission to Operate
  5. CCL03 Request for Nighttime Care Specialization
  6. CCL04 Request for Specialized Program Activity
  7. CCL06 Administrator Designation and Qualification Form
  8. CCL07 Child Care Facility Administrator Reference
  9. CCL10 Child Care Facility Parent Policies Checklist
  10. CCL11 Parents’ Guide to Licensed Care
  11. CCL12 Child Care Facility Personnel Policies Checklist
  12. CCL13 Child Care Facility Staffing Plan
  13. CCL14 Get Out Alive! … Evacuation Plan
  14. CCL15 First Aid and Disaster Kit Checklist
  15. CCL17 Alternate Outdoor Recreation Space – H
  16. CCL18 Emergency Evacuation Drill Report
  17. CCL19 Plan for Care for a Child with Special Needs
  18. CCL20 Emergency Caregiver Designation and Qualification Form – H
  19. CCL21 Firearms and Ammunition Storage – H
  20. CCL22 Plant Safety Plan
  21. Things to Ponder - H
  22. Application Resources – H
  23. First Aid and CPR Training Resources – H
  24. Child Care Licensing Fees
  25. Noncriminal Justice Applicant's Privacy Rights