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Child Care Licensing

Florida Department of Health in Pinellas County, Child Care Licensing


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Spanish forms are listed below the English versions.

The following forms are in Adobe Acrobat and some of them can be completed online and printed. 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.

FormsNumber
Accident/Incident Record
F-0041
Addendum to Emergency Evacuation Plan
F-0004B
Registro de Incidentes y Accidentes
F-0041-S
Formulario de Reconocimiento de Requisitos de Informes Sobre el Abuso y Descuido de Niños
FC-0071-S
Attestation of Good Moral Character
CF-1649
Attendance Record
F-0022
Breast Milk Storage
Capacity Chart 
Caregiver's Policy F-0031
Politica Del Cuidador
F-0031S
Central Abuse Hotline Records Search Form
FC-1651
Child Abuse and Neglect Reporting Requirements/Acknowledgement
CF-FSP-5337
Child ID Record / Emergency Medical Form
F-0030A
Registro de Identificación del Niño (Child's Identification Form) - SpanishF-0030-S
Cleaning Schedule Sample
Clearinghouse Renewals FAQ
Daily Indoor/Outdoor ChecklistF-307
Diapering Practices
FC-2021
Discipline/Expulsion Policy
Discipline Policy
POLÍTICA DE DISCIPLINA
Expulsion Policy
F-0071A
F-0071
F-0071S
F-0071B
Distracted Driver 
Adulto Distraído
Distracted Adult/Distracted Driver Sign-Off
Autorización para Cuidados de Emergencia
FC-0003
Emergency Regulations 
Emergency Telephone NumbersF-0016
Employment History FormF-0020A
Employer Verification FormF-0020B
Exposure Control Refresher Training
Exposure Control Refresh Training Sign-Off		F-0072
F-0072A
Family Child Care Associations
Family Child Care Home Checklist with form
F-0057B
Field Trip Permission
F-0021
Fire Drill Emergency Preparedness Record
FC-0075
Fire Extinguisher Training
F-0076
Fire Extinguisher Vendors
First Aid/CPR Training Vendors
Flu Brochure 
Flu Brochure (CFPI175-70 June 2009) - Spanish 
Flu Brochure Sign Off
Hand washing-When and How
Know Your Family Child Care Home Brochure
F-0040
Folleto: Conozca a Su Guardería en el Hogar
F-0040-S
Large Home Plan of Operation Form
F-0055
Large Home Requirements for Temporary Permit
F-0058
Medication Record and Parent Authorization
F-0010
Modified Diet
F-0014
Moving a Large Child Care Home to a New Residence
F-0025A
Moving to a New Residence
F-0025
Parent Reminder
C-0101
Physical Examination for Driver
C-0078
Plan for Evacuation-Homes
F-0004A
Plan for Reporting and Managing Incidents
F-0005
Planned Days Closed
Plan of Operation
F-0004
Pool Letter for Parents
F-0302
Prevention of Shaken Baby Syndrome and Abusive Head Trauma Plan
Recordkeeping
F-0100
Request for Change of License
F-0006
Requirements for Employees
F-0002B
Requirements for Substitutes
F-0002A
Rilya Wilson Act 
Shaken Baby Syndrome and Abusive Head Trauma
Steps to Registering in the ClearinghouseF-0101
Thank You for Your Interest
F-0057
Tips for Fire Drills
T-001
Training Dates and Hours
F-0077
Transportation Log
F-0092
Vehicle Inspection ReportF-0094
Volunteer Affidavit
F-0303
Walking Field Trip LogF-0093
WHO Guidelines for Powdered Formula 
Zoning AttestationF-0053C