Licensing forms are available as printable PDF documents below. They must be completed manually.
Begin opening a form by clicking on its name or number. Next print the form and then fill in the required responses. Then mail the document to the appropriate Office of Child Care Regional Licensing Office.
If you have any questions about the use of a form, please contact your Regional Licensing Office.
Please note that the following indicators are used to define what type of child care facility each form represents:
(HOME/LFCCH) - family child care homes (small) and large family child care homes
(HOME) - family child care homes (small) only
(LFCCH) - large family child care homes only
(CTR/LOC) - child care centers and letter of compliance facilities
(CTR) - child care centers only
(LOC) - letter of compliance facilities only
(ALL) - centers, homes (small and large), and letter of compliance facilities
Checklists
Please print the desired "checklist" to use as a guide when selecting the appropriate forms required.
Application - Child Care Center or Letter of Compliance
Continuing Application - Child Care Center
Continuing Application - Family Home
Continuing Application - Large Family
Child Care Center and Letter of Compliance Application Resource Guide
Family Child Care Application Resource Guide
Large Family Child Care Application Resource Guide
Application for Resumption of Services
Application of Nonpublic Nursery Schools
Forms
[DHMH 896] Immunization Certificate (ALL)
[DHMH 4620] Blood Lead Testing Certificate (ALL)
[100] Record of Professional Development Coursework (ALL)
[101] Record of Pre-Service Training for Family Child Care: Prior to becoming registered, Family Child Care providers are required to complete a minimum of 4 clock hours of approved training in each of the 6 Core of Knowledge areas in addition to other mandated training. The Core of Knowledge areas are: Child Development (Child Dev), Curriculum (Curr), Heath, Safety and Nutrition (HSN), Special Needs (Spe N), Professionalism (Prof), and Community (Comm).
[200] Application to Operate An Educational Program – Nonpublic Nursery School
[201] Nonpublic Nursery School Personnel Record
[300] Reportable Child Incident Form
[672] Child Care Center Request for Continuing License or LOC
[673] Request for Continuing Family Child Care Home Registration
[675] Request for Continuing Large Family Child Care Home Registration
[1200] Child Care Center Application for License (LOC): This form may be used to apply for a Child Care Center License or a Letter of Compliance
[1201] Worker’s Compensation Insurance Information (LFCCH / CTR / LOC)
[1202] Family Child Care Residents and Personnel Form
[1203] Personnel List and Staff Change Report (LFCCH / CTR / LOC)
[1203] Personnel List and Staff Change Report - (Fill-in Version ) (LFCCH / CTR / LOC)
[1204] Medical Report for Child Care (ALL)
[1205] Personnel Information (LFCCH / CTR)
[1206] Staffing Pattern (LFCCH / CTR / LOC)
[1209] Change in Facilities (LFCCH / CTR / LOC): Child Care Center regulations (COMAR 13A.16.03.07) and Letter of Compliance regulations (COMAR 13A.17.03.07) require that any changes in operation be approved by the Office of Child care (OCC). Examples include capacity, hours of operation, rooms used for care, and ages of children served. Obtain written approval from OCC before making the proposed change.
[1213] Variance Request (ALL)
[1214] Emergency Form (ALL)
[1215] Health Inventory (ALL)
[1216] Medication Administration Authorization Form
[1216A] Asthma Action Plan And Medication Administration Authorization Form (ALL)
[1216B] Allergy and Anaphylaxis Medication Administration Authorization Form
[1216C] Seizure/Convulsion/Epilepsy Disorder Medication Administration Authorization Form
[1216D] Special Health Condition Individualized Care Plan Checklist
[1216E] Topical Basic Care Product Application Approval
[1216F] Medication Error Incident Report
[1218] Menu Plans (LFCCH / CTR / LOC)
[1228] Family Child Care Substitute Record
[1229] Substitute Form (HOME / LFCCH)
[1230] Family Child Care Home Application
[1240] Large Family Child Care Home Application
[1260] Release of Information (ALL)
[1260A] Release of Information for Out of State
[1261] Emergency Escape Plan (HOME)
[1262] Fire and Disaster Drill Log
[1267] Provider Information and Plan of Operation (HOME)
[1268] Environmental Health Survey (ALL)
[1270] Notice of Intent to Operate (CTR / LOC)
[1270A] Preliminary Inspection of Child Care Facility
[1275] Additional Adult Application (HOME)
[1279] On-Call Agreement (LFCCH / CTR / LOC)
[1281] Request for Hearing (ALL)
[1282A] Voluntary Surrender of a Family Child Care Registration (HOME)
[1282B] Voluntary Surrender of Large Family Child Care Registration (HOME)
[1282C] Voluntary Surrender of Child Care Center License
[1282D] Voluntary Surrender of Letter of Compliance
[1283] Voluntary Closure for a Child Care Facility (ALL)
[1285] Health History – Drop In (CTR)
[1297] Child Care Facility Self-Assessment
Accident/Injury Record (ALL)
Daily Attendance Record (ALL)
Facility and Other Emergency Numbers (ALL)
Infant Toddler Daily Food Intake and Activities (ALL)
Infant Toddler Checklist (HOME)
Permission Slip - Offsite Activities (ALL)
Permission Slip - Swimming/Wading Activities (ALL)
Staff Orientation Verification (LFCCH / CTR / LOC)
Substitute/Additional Adult/Volunteer Orientation Verification: This is the former substitute orientation verification form revised to include use by additional adults and volunteers – (revised 11/7/16) (HOME)
Translated Forms
En Espanol (Currently being updated)
Publique esta información en un lugar de fácil acceso para el personal
Registro de Simulacro de Incendio
Formulario De Preinscripción En Livescan
[OCC 101] Expediente de capacitación aprobada previa al Servicio para Solicitantes de Cuidado Infantil Familiar
[OCC 349] Solicitud Para Reanudar el Servicio
[OCC 673] Solicitud Para Continuar La Inscripción De Guardería Familiar
[OCC 1204] Informe Médico Para Cuidado Infantil
[OCC 1214] Formulario de Emergencia
[OCC 1215] Inventario de Salud
[OCC 1216] Expediente de capacitación aprobada previa al Servicio para Solicitantes de Cuidado Infantil Familiar
[OCC 1229] Formulario de Sustituto
[OCC 1230] Solicitud de Inscripción de Guardería Familiar
[OCC 1260] Divulgación de Información – Cuidado Infantil
[OCC 1275] Solicitud de Adulto Adicional
[OCC 1295] Guía de Autoevaluación de Guardería Infantil
Verificación de Orientación de Sustituto
Lista de Verificación Para La Entrega de Información de 24 Meses
Hindi
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