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Child Care Licensing

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


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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.

FormsNumber
Accident/Incident Record
F-0041
Addendum to Emergency Evacuation Plan
F-0004B
Registro de Incidentes y Accidentes
F-0041-S
Child Abuse & Neglect ReportingAcknowledgement Form
FC-0071
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 ID Record / Emergency Medical Form
F-0030A
Registro de Identificación del Niño (Child's Identification Form) - SpanishF-0030-S
Cleaning Schedule Sample
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 brochure Spanish
(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 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
Flu Brochure (CFPI175-70 June 2009) - English 
Flu Brochure (CFPI175-70 June 2009) - Spanish 
Getting In Getting Out Flyer
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
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
Plan of Operation
F-0004
Pool Letter for Parents
F-0302
Prevention of Shaken Baby Syndrome & Abusive Head Trauma Plan
Recordkeeping
F-0100
Request for Change of License
F-0006
Requirements for Employees
F-0002B
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