Pinellas County Health Department


Child Care License Program

Young boy measuring girl's height

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© 2007 State of Florida

Forms available in Spanish are listed below the English titles.

The following forms are set up in Adobe format. You may complete 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 507-4857.

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Forms
Number
Accident/Incident Record
F-0041
Acknowledgment Form Child Abuse & Neglect Reporting
FC-0071

Affidavit of Good Moral Character

FC-1649
Attendance Record
C-0021

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
DCF Mandated Reporter  
Discipline Policy Sample
F-0071
Driver's Attendance Log
F-0024
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 El Hogar De Cuidado De Niños Y El Hogar De Cuidado De Niños Con Capacidad Extendida Al Que Asiste Su Niño

F-0040
Large Family Child Care Home Fire Drill Record
F-0062
Local Police Background Check
F-0013
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
Training Dates and Hours
F-0077
Verification of Employment 
F-0020A
Volunteer Affidavit
FC-0072


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