skip to content

Childcare Licensing

FL Dept of Health in Pinellas - Pinellas County Child Care Licensing Program


pclb header with logo

Family Child Care Home Forms 

Forms available in Spanish are listed below the English titles.

The following forms are set up in Adobe format. You may complete some of them on-line and print them out. Many of the lines on the forms are set to auto font, which means the font will adjust to the number of characters you type on each line. If the tab does not work simply point and click on the next line to move your cursor.

If you have any questions, please call 727-507-4857.

Forms Number
Accident/Incident Record
F-0041
Attachment 3  
Child Abuse & Neglect Reporting
Acknowledgement Form
FCCH-0071
Addendum to Plan of Operation and Evacuation  
Affidavit of Good Moral Character
CF-1649
Attendance Record
F-0022
Capacity Chart  
Caregiver's Policy
F-0031
Central Abuse Hotline Records Search Form 1651
CF-1651
Child's ID Record
(Expediente de Identificacion del Niño)
F-0030
Discipline Policy Sample
F-0071
Emergency Regulations  
Emergency Medical Release Form
(Autorización para Cuidados de Emergencia)
FC-0003
Evacuation Preparedness Record
FC-0073
Field Trip Permission
F-0021
Fire Drill Record
FC-0074F
Flu Brochure (CFPI175-70 June 2009) - English  
Flu Brochure (CFPI175-70 June 2009) - Spanish  
Indoor Premises Inspection
FC-0075
Know Your Family Child Care Home Brochure
(Conozca a su Familia el Cuidado de Niños Inicio - folleto)
F-0040
Local Police Background Check
F-0013
Medication Log
(Expediente de Medicacion)
F-0010
Modification of Diet
F-0014
Moving to a New Residence
F-0025
Outdoor Maintenance Inspection
FC-0076F
Plan of Operation
F-0004
Pool Letter for Parents
F-0302
Recordkeeping
(Mantenimiento de Expedientes del Hogar de Cuidado de Niños)
F-0100
Release of Information Sheet
F-0027
Request for Change of License
F-0006
Thank You for Your Interest
F-0057
Thank You for Your Interest-Large
F-0063
Training Dates and Hours
F-0077
Transportation Log
F-0092
Verification of Employment
F-0020A
Volunteer Affidavit
FC-0072