Licensing Forms & Documents for Providers




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General Licensed Child Care Forms
Background Check Form
Background check form for child care workers.

Background Check Form File Format: Adobe Acrobat (PDF) [49k]
Background Check Form (Spanish) File Format: Adobe Acrobat (PDF) [51k]
Background Check Form File Format: Microsoft Word (DOC) [253k]
Background Check Form (Spanish) File Format: Microsoft Word (DOC) [271k]
Certificate of Immunization Status Form
Washington State Department of Health Certificate of Immunization Status form.

Certificate of Immunization Status Form (English) File Format: Adobe Acrobat (PDF) [100k]
Certificate of Immunization Status Form (Spanish) File Format: Adobe Acrobat (PDF) [177k]
Child Care Agreement
Financial agreement.

Child Care Agreement File Format: Adobe Acrobat (PDF) [26k]
Child Care Agreement (Spanish) File Format: Adobe Acrobat (PDF) [31k]
Child Care Agreement File Format: Microsoft Word (DOC) [185k]
Child Care Agreement (Spanish) File Format: Microsoft Word (DOC) [188k]
Child Care Registration
Child Care Registration Form.

Child Care Registration File Format: Adobe Acrobat (PDF) [41k]
Child Care Registration (Spanish) File Format: Adobe Acrobat (PDF) [48k]
Child Care Registration File Format: Microsoft Word (DOC) [219k]
Child Care Registration (Spanish) File Format: Microsoft Word (DOC) [210k]
Daily Attendance Records
Attendance record form for child care facilities.

Daily Attendance Records File Format: Adobe Acrobat (PDF) [244k]
Daily Attendance Records (Spanish) File Format: Adobe Acrobat (PDF) [28k]
Daily Attendance Records File Format: Microsoft Word (DOC) [81k]
Daily Attendance Records (Spanish) File Format: Microsoft Word (DOC) [257k]
Fire Safety Record
Fire Safety Record and Evacuation Plan.

Fire Safety Record File Format: Adobe Acrobat (PDF) [202k]
Fire Safety Record (Spanish) File Format: Adobe Acrobat (PDF) [220k]
Fire Safety Record File Format: Microsoft Word (DOC) [208k]
Fire Safety Record (Spanish) File Format: Microsoft Word (DOC) [210k]
Injury/Incident Report
Child injury form.

Injury/Incident Report File Format: Adobe Acrobat (PDF) [84k]
Injury/Incident Report (Spanish) File Format: Adobe Acrobat (PDF) [41k]
Injury/Incident Report File Format: Microsoft Word (DOC) [198k]
Injury/Incident Report (Spanish) File Format: Microsoft Word (DOC) [77k]
Reconsideration Request Form
Form to request a reconsideration.

Reconsideration Request Form File Format: Adobe Acrobat (PDF) [33k]
Reconsideration Request Form File Format: Microsoft Word (DOC) [184k]
School Based and Military Certification for Payment Only Request Form
Form to request certification for payment only.

School Based and Military Certification for Payment Only Request Form File Format: Adobe Acrobat (PDF) [50k]
School Based and Military Certification for Payment Only Request Form File Format: Microsoft Word (DOC) [170k]
Tribal Certification Request Letter Template
Form to request Tribal certification for payment only.

Tribal Certification Request Letter Template File Format: Adobe Acrobat (PDF) [6k]
Tribal Certification Request Letter Template File Format: Microsoft Word (DOC) [41k]

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School-Age and Center Provider Forms
Child Care Center Director/Program Supervisor Notice of Change
Child care center or school age director/program supervisor notice of change.

Child Care Center Director/Program Supervisor Notice of Change File Format: Adobe Acrobat (PDF) [56k]
Child Care Center Director/Program Supervisor Notice of Change File Format: Microsoft Word (DOC) [184k]
Child Care Center Feasibility Checklist
Licensing checklist form for child care centers.

Child Care Center Feasibility Checklist File Format: Adobe Acrobat (PDF) [109k]
Child Care Center Feasibility Checklist File Format: Microsoft Word (DOC) [217k]
Child Care Center Licensing Checklist
Licensing checklist form for child care centers.

Child Care Center Licensing Checklist File Format: Adobe Acrobat (PDF) [217k]
Child Care Center Licensing Checklist File Format: Microsoft Word (DOC) [681k]
Child Care Center Monitoring Checklist
Monitoring checklist form for child care centers.

Child Care Center Monitoring Checklist File Format: Adobe Acrobat (PDF) [217k]
Child Care Center Monitoring Checklist File Format: Microsoft Word (DOC) [681k]
Center and School-Age Licensing Application
Licensing Application form for Centers & School-age facilities. You must attend DEL orientation before submitting a licensing application.

Center and School-Age Licensing Application File Format: Adobe Acrobat (PDF) [223k]
Center and School-Age Licensing Application File Format: Microsoft Word (DOC) [570k]
Center and School-Age Application for Employment
Application for Employment in a licensed child care facility.

Center/SA Application for Employment File Format: Adobe Acrobat (PDF) [174k]
Center/SA Application for Employment File Format: Microsoft Word (DOC) [360k]
School-Age Licensing Checklist
Licensing Checklist form for School-age Programs.

School-Age Licensing Checklist File Format: Adobe Acrobat (PDF) [210k]
School-Age Licensing Checklist File Format: Microsoft Word (DOC) [480k]
School-Age Monitoring Checklist
Licensing Checklist form for School-age Programs.

School-Age Monitoring Checklist File Format: Adobe Acrobat (PDF) [210k]
School-Age Monitoring Checklist File Format: Microsoft Word (DOC) [480k]

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Family Home Provider Forms
Family Home Licensing Application
Licensing Checklist form for Family Home Child Care. You must attend DEL orientation before submitting a licensing application.

Licensing Application form for Family Home Child Care File Format: Adobe Acrobat (PDF) [250k]
Licensing Application form for Family Home Child Care (Spanish) File Format: Adobe Acrobat (PDF) [283k]
Licensing Application form for Family Home Child Care File Format: Microsoft Word (DOC) [280k]
Licensing Application form for Family Home Child Care (Spanish) File Format: Microsoft Word (DOC) [279k]
Family Home Licensing Checklist
Licensing Checklist form for Family Home Child Care.

Family Home Licensing Checklist File Format: Adobe Acrobat (PDF) [250k]
Family Home Licensing Checklist (Spanish) File Format: Adobe Acrobat (PDF) [283k]
Family Home Licensing Checklist File Format: Microsoft Word (DOC) [280k]
Family Home Licensing Checklist (Spanish) File Format: Microsoft Word (DOC) [279k]
Family Home Monitoring Checklist
Monitoring Checklist form for Family Home Child Care.

Family Home Monitoring Checklist File Format: Adobe Acrobat (PDF) [181k]
Family Home Monitoring Checklist (Spanish) File Format: Adobe Acrobat (PDF) [189k]
Family Home Monitoring Checklist File Format: Microsoft Word (DOC) [280k]
Family Home Monitoring Checklist (Spanish) File Format: Microsoft Word (DOC) [279k]
Family Home Permission Authorization
Parent/guardian permission authorization form for family home child care.

Family Home Permission Authorization File Format: Adobe Acrobat (PDF) [37k]
Family Home Permission Authorization (Spanish) File Format: Adobe Acrobat (PDF) [25k]
Family Home Permission Authorization File Format: Microsoft Word (DOC) [42k]
Family Home Permission Authorization (Spanish) File Format: Microsoft Word (DOC) [166k]
Family Home Probation Notification Letter to Parents from Provider
Parent/guardian permission authorization form for family home child care.

Probation Notification Letter File Format: Adobe Acrobat (PDF) [35k]
Probation Notification Letter File Format: Microsoft Word (DOC) [34k]
Family Home Provider/Assistant Resume Form
Provider/assistant resume form for family home child care.

Family Home Provider/Assistant Resume Form File Format: Adobe Acrobat (PDF) [55k]
Family Home Provider/Assistant Resume Form (Spanish) File Format: Adobe Acrobat (PDF) [38k]
Family Home Provider/Assistant Resume Form File Format: Microsoft Word (DOC) [99k]
Family Home Provider/Assistant Resume Form (Spanish) File Format: Microsoft Word (DOC) [243k]
Family Home Request to Change Capacity
Family child care capacity change request form.

Family Home Request to Change Capacity File Format: Adobe Acrobat (PDF) [158k]
Family Home Request to Change Capacity (Spanish) File Format: Adobe Acrobat (PDF) [47k]
Family Home Request to Change Capacity File Format: Microsoft Word (DOC) [228k]
Family Home Request to Change Capacity (Spanish) File Format: Microsoft Word (DOC) [223k]

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News and information
Child Care Subsidies [2,712k]
File Format: Adobe Acrobat (PDF)
A booklet for licensed and certified child care providers.
Directors List of Crimes and Negative Actions [12k]
File Format: Adobe Acrobat (PDF)
List of crimes whereby applicant must not be allowed unsupervised access to children until five years have passed since the date of the conviction.
Employment of Blind and Visually Impaired [146k]
File Format: Adobe Acrobat (PDF)
Memorandum of Understanding to clarify the Department's policy as to the employment of blind and visually impaired workers at child care facilities.
FRAUD [27k]
File Format: Adobe Acrobat (PDF)
Division of Fraud Investigations (DFI) WAC 388-446-001 Fraud Early Detection program (FRED).
Letter sent to all licensed child care providers by mail on October 30 regarding background checks for employees
Background check letter to child care providers explaining the importance of conducting background checks within seven days of the first day of employment on all employees who have contact with children.
Letter sent to all licensed child care providers by mail on October 30 regarding background checks for employees File Format: Adobe Acrobat (PDF) [48k]
Letter sent to all licensed child care providers by mail on October 30 regarding background checks for employees (Spanish) File Format: Adobe Acrobat (PDF) [51k]
Licensed Child Care in Washington State: A Guide for Child Care Providers [10MB]
File Format: Adobe Acrobat (PDF)
A DEL handbook intended to better support newly licensed child care providers, as well as answer common questions for people who are thinking about becoming licensed.
Supplemental brochures
Summary Suspensions and Revocations File Format: Adobe Acrobat (PDF) [681k]
Disqualifications File Format: Adobe Acrobat (PDF) [626k]
Compliance Agreements File Format: Adobe Acrobat (PDF) [127k]
Policy Memorandum Implementation of Chapter 299, Laws of 2077 Window Blind Cords Child Care Settings [51k]
File Format: Adobe Acrobat (PDF)
Policy memo about state law prohibiting the use of window blinds or other window coverings with pull cords or inner cords capable of forming a loop and posing a risk for strangulation to young children.
Reminder to Families to Report Changes for Child Care Needs [51k]
File Format: Adobe Acrobat (PDF)
Reminder to families to report changes for child care needs for the summer to the Working Connnections Child Care Office.
Seasonal Day Camps - Summer 2008 [91k]
File Format: Adobe Acrobat (PDF)
Lists summer day camp programs in the cities of Seattle, Tacoma, and Spokane.
Shortage of Syrup of Ipecac [70k]
File Format: Adobe Acrobat (PDF)
Notice to providers explaining the shortage of Ipecac in Washington State.
STARS Brochure [46k]
File Format: Adobe Acrobat (PDF)
Caring for and educating children is work that is both rewarding and challenging. Continued education enable professionals to do their best work and ensure the availability of high quality care.
Window Blind Information
Questions and answers on use of window coverings in licensed child care in accordance with RCW 43.215.360.
July 2008 Frequently Asked Questions on State Window Blind Cord Law File Format: Adobe Acrobat (PDF) [139k]
July 2008 Frequently Asked Questions on State Window Blind Cord Law (Spanish) File Format: Adobe Acrobat (PDF) [40k]
Window Blind Letter to Child Care Providers (April 2008) File Format: Adobe Acrobat (PDF)[74k]

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Licensing Rule Making
2006-07 Comments Received on Emergency Rules - DEL Background Check WAC 170-06 [226k]
File Format: Adobe Acrobat (PDF)
Comments on DEL Background Check Emergency Rules (WAC Chapter 170-06). The information is presented in table format and represents comments received from child care providers, parent advocates, union representatives and other stakeholders from November 2006 through August 2007.
Crosswalk Between Proposed and Emergency DEL Background Check Rules, and Between Background Check Rules and DEL Licensing Rules [255k]
File Format: Adobe Acrobat (PDF)
Crosswalk of proposed, emergency and licensing rules in table format. Table describes proposed changes to the Licensing WAC chapters to make those rules compatible with the proposed new Background Check WAC chapter.
Emergency Rule Notice - DEL Background Check Rules (June 2004) [797k]
File Format: Adobe Acrobat (PDF)
The purpose of this rule is to allow the new Department of Early Learning to continue performing background clearances on and providing due process hearing procedures to child care providers after the department separated from the Department of Social and Health Services and became a new department on July 1, 2006.
Laws that Govern the Department of Early Learning Background Check Rules [80k]
File Format: Adobe Acrobat (PDF)
List of Washington State laws concerning the Department of Early Learning Background Checks.
Negotiated Rule Making Team (NRMT) Meetings (2007)

File Format: Adobe Acrobat (PDF)
Notes, comments, and other documents from the NRMT meetings held during 2007.

January 6, 2007 (Pasco) - Meeting Notes [92k]
January 6, 2007 (Pasco) - Meeting comments [62k]
January 20, 2007 (Kent) - Meeting Notes [30k]
January 20, 2007 (Kent) - Meeting comments [54k]
April 21, 2007 [28k]
May 19, 2007 (Ellensburg) [94k]
June 16, 2007 (North Bend) [65k]
August 11, 2007 (Ellensburg) - Meeting notes [74k]
August 11, 2007 (Ellensburg) - A TeamsStaff qualifications [34k]
August 11, 2007 (Ellensburg) - C & C Team Special programs [48k]
August 11, 2007 (Ellensburg) - C&C Team Program [27k]
August 11, 2007 (Ellensburg) - C&C Team Corrective action [42k]
August 11, 2007 (Ellensburg) - West Side Story Guiding principles [40k]
September 15, 2007 (Issaquah) - Meeting Notes [62k]
October 27, 2007 (Yakima) - Meeting Notes [76k]
December 8, 2007 (Seattle) - Meeting Notes [64k]
Negotiated Rule Making Team (NRMT) Meetings (2008)

File Format: Adobe Acrobat (PDF)
Notes, comments, and other documents from the NRMT meetings held during 2008.

January 12, 2008 (Seattle) - Meeting Notes [66k]
March 8, 2008 (Spokane) - Meeting Notes [260k]
April 12, 2008 (Yakima) - Meeting Notes [287k]
June 21, 2008 (Ellensburg) - Meeting Notes [66k]
June 21, 2008 (Ellensburg) - Septic and Drinking Water PowerPoint Presentation by Washington State Child Health & Safety Advisory Committee [66k]
June 21, 2008 (Ellensburg) - Additional Health Materials from NRMT Questions to Public Health [425k]
October 25, 2008 (Renton and Yakima linked by video conference) - Meeting Notes [420k]
Negotiated Rule Making Team Roster (by Sub-Team) updated October 25, 2008 [47k]
File Format: Adobe Acrobat (PDF)
List and contact information for members of DEL Negotiated Rule Making Team (by Sub-Team).
Negotiated Rule Making - Topic List for Redesigning Chapter 170-296 WAC [48k]
File Format: Adobe Acrobat (PDF)
Chart of suggested topics for redesigning the Family Home Child Care WACs, adopted by the Negotiated Rule Making Team.
Proposed Background Check Rules, Chapter 170-06 WAC Comments (March 12 through March 14, 2008) [108k]
File Format: Adobe Acrobat (PDF)
E-mail comments received by the Department of Early Learning on the proposed rules from March 12 through March 14, 2008.
Questions and Answers on Proposed DEL Background Check Rules (March 12, 2008) [79k]
File Format: Adobe Acrobat (PDF)
List of frequently asked questions on background check rules and their accompanying answers.
Semi-Annual Rule Making Agenda Under RCW 34.05.314
File Format: Adobe Acrobat (PDF)
Department of Early Learning prepares a semi-annual rule making agenda in January through July of each year to let the public know about DEL rules underway or planned during the report period.
Semi-Annual Rule Making Agenda Under RCW 34.05.314 (January - June 2009) [101k]
Semi-Annual Rule Making Agenda Under RCW 34.05.314 (July - December 2009) [133k]
Summary of Preliminary Draft Background Check Rules (February 11, 2008) [162k]
File Format: Adobe Acrobat (PDF)
Memo to parents, child care providers, other interested parties regarding DEL background check draft rules for review and comment.
Summary of Proposed DEL Background Check Rules (March 12, 2008) [167k]
File Format: Adobe Acrobat (PDF)
DEL asks for input on proposed new Washington Administrative Code (WAC) Chapter 170-06, DEL Background Check Rules, and related changes to child care licensing WAC chapters 170-151, 170-295, and 170-296.

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