Go to Child Care Licensing Forms; Last Updated: 10/15/2015. Al ingresar Spanish en el campo “Search”, se mostrarán sólo los documentos que estén traducidos a ese idioma. Wisconsin Family Child Care Forms. Information for Families and Child Care Providers (DCF-P-PFS503-S), Safety and Emergency Response Documentation - Group Child Care Centers (DCF-F-CFS0543), Applicant/Licensee Rights and Responsibilities (DCF-P-PFS0602), Solicitante / Licenciatario Derechos y Responsabilidades (DCF-P-PFS0602-S), Initial License Application - Day Camps for Children (DCF-F-CFS782-E), Child Record Checklist - Child Care Centers (DCF-F-CFS1675), Child Record Checklist - Child Care Centers (DCF-F-CFS1675-E), Staff Record Checklist - Group Child Care Centers (DCF-F-CFS1675A), Staff Record Checklist - Group Child Care Centers (DCF-F-CFS1675A-E), Ordering Information - Inquiry Packets (DCF-F-CFS2022), Staff Orientation Checklist - Group Child Care Centers (DCF-F-CFS2026), Staff Orientation Checklist - Group Child Care Centers (DCF-F-CFS2026-E), Volunteer Training Confirmation - Group Child Care Centers (DCF-F-CFS2027), Policy Checklist - Group Child Care Centers (DCF-F-CFS2048), Staff Record Checklist - Family Child Care Centers (DCF-F-CFS2051), Staff Record Checklist - Family Child Care Centers (DCF-F-CFS2051-E), Continuing Education Record - Independent Reading / Video Viewing (DCF-F-CFS2114), Continuing Education Record - Independent Reading / Video Viewing (DCF-F-CFS2114-E), Initial Licensing Checklist - Family Child Care Centers (DCF-F-CFS2241), Initial Licensing Checklist - Group Child Care Centers (DCF-F-CFS2242), Staff Orientation Checklist - Family Child Care Centers (DCF-F-CFS2255), Staff Orientation Checklist - Family Child Care Centers (DCF-F-CFS2255-E), Lista de verificación orientativa para el personal - Centros de cuidado infantil familiar (DCF-F-CFS2255-S), Building Inspection Report - Licensed Child Care Centers (DCF-F-CFS2344), Health History and Emergency Care Plan (DCF-F-CFS2345), Health History and Emergency Care Plan (DCF-F-CFS2345-E), Historial de salud y plan de atención de emergencia (DCF-F-CFS2345-S), Policy Checklist - Family Child Care Centers (DCF-F-CFS2356), Lista de Verificación de la Política - Centros de Cuidado Infantil Familiar (DCF-F-CFS2356-S), Pre-Camp Training Documentation - Day Camps (DCF-F-2405), Pre-Camp Training Documentation - Day Camps (DCF-F-2405-E), Policy Checklist - Day Camps (DCF-F-2409), Counselor-to-Child Ratio Worksheet - Day Camps for Children (DCF-F-2424), Counselor-to-Child Ratio Worksheet - Day Camps for Children (DCF-F-2424-E), Your Guide to Regulated Child Care - Summary of the Child Care Rules (DCF-P-2436), Su guia para el cuidado infantil regulado - su resumen de las reglas del cuidado infantil (DCF-P-2436-S), Daily Attendance Record - Licensed Child Care Centers (DCF-F-2438), Daily Attendance Record - Licensed Child Care Centers (DCF-F-2438-E), Registro de asistencia diaria - Centros de cuidado infantil con licencia (DCF-F-2438-S), Child Record Checklist - Day Camps for Children (DCF-F-2452), Child Record Checklist - Day Camps for Children (DCF-F-2452-E), Staff Record Checklist - Day Camps for Children (DCF-F-2453), Staff Record Checklist - Day Camps for Children (DCF-F-2453-E), Counselor-to-Child Ratio While Swimming Worksheet - Day Camps for Children (DCF-F-2455), Counselor-to-Child Ratio While Swimming Worksheet - Day Camps for Children (DCF-F-2455-E), Instructions for Obtaining Forms - Day Camps for Children (DCF-P-2456), Staff-to-Child Ratio While Swimming Worksheet - Group and Family Child Care (DCF-F-2465), Potential Barriers to Obtaining a Child Care Center License (DCF-P-2562), Potenciales Impedimentos para la Obtención una Licencia para un Centro de Cuidado Infantil (DCF-P-2562-S), Email Subscription Service BECR (DCF-P-2563), Instructions for Obtaining Forms - Group & Family Child Care Centers (DCF-P-PFS3038), Procedure for Obtaining an Initial License to Operate a Group Child Care Center (DCF-P-PFS3066), Student Immunization Record (DHS F-04020L), Registro de Vacunas del Estudiante (DHS F-04020LS), Procedure for Obtaining an Initial License to Operate a Day Camp for Children (DCF-P-PFS4065), Procedure for Obtaining an Initial License to Operate a Family Child Care Center (DCF-P-PFS4066), Procedimiento de Obtención de una Licencia Inicial Para Dirigir un Centro de Cuidado Infantil Familiar (DCF-P-PFS4066-S), Use of 10+ Passenger Vans To Transport Children To and From Schools (DCF-P-PFS4088), Entry-Level Non-Credit Courses for Licensed Child Care (DCF-P-PFS4091), Cursos de nivel inicial sin créditos para centros de cuidado infantil con licencia (DCF-P-PFS4091-S), Instructions for Obtaining Child Care Licensing Rule Books and Commentary Manuals, Health and Safety Checklist - Public School Operated Programs (DCF-F-5154), Barred Offenses (Crimes Table) - Regulated Child Care (DCF-P-5206), Staff Record Checklist - Public School Operated Child Care (DCF-F-5209), Background Check Checklist - Current Providers With Employees Hired Before 10/01/2018 (DCF-P-5286), Keeb Kwm Dhau Los Txheeb Xyuas Cov Lus Thov (DCF-F-5296-H), Solicitud de Verificación de antecedents (DCF-F-5296-S), Background Check Checklist - Current Providers With New Employees (DCF-P-5301), Background Check Checklist - New Providers (DCF-P-5302), Child Care Background Check Role Chart (DCF-P-5317), Background Check Checklist - Educational Institutes and Colleges (DCF-P-5318), Background Check Checklist - Contracting and Staffing Agencies (DCF-P-5319), Petition for Appeal of Ineligibility Determination (DCF-F-5331-E), Child Care Background Checks - Licensor Desk Aid, Verificaciones de antecedentes para cuidados infantiles - Servicio de asistencia para especialistas en licencias, Child Care Background Check Attestation (DCF-F-5365), Declaración de Verificación de Antecedentes para Cuidados Infantiles (DCF-F-5365-S), Portal Quick Reference Guide - CCPP and iChildCare (DCF-P-5386), Storing and Warming Infant Bottles and Food (DCF-P-5396), Required Items for Family Child Care Centers (DCF-P-5414), Required Items for Group Child Care Centers (DCF-P-5421), Required Items for Day Camps for Children (DCF-P-5422), Child Care Immunization Record (DHS F-44192), Registro De Inmunizaciones Para Guardería Infantil (DHS F-44192S), Ua Npe Zwm Rau Hauv Chaw Zov Me Nyuam (DCF-F-CFS0062-H), Inscripción en el Servicio de Cuidado Infantil (DCF-F-CFS0062S), Bureau of Early Care Regulation Regional Office Information (DCF-P-PFS3059), Center Medication and Injury Log - Directions for Use (DCF-P-5185), Registro de Lesiones y Medicamentos del Centro - Instrucciones de Uso (DCF-P-5185-S), DCF Approved Agencies Offering Non-Credit Courses (DCF-P-5202), Cleaning, Sanitizing, and Disinfecting in Child Care Settings (DCF-P-5201), Wisconsin Shares Participation Contract (DCF-F-2587), Contrato de Participacion en Wisconsin Shares (DCF-F-2587), Driver Training Checklist - Child Care Centers (DCF-F-5383-E), Driver Training Checklist - Child Care Centers (DCF-F-5383). The following family child care forms are provided by the State of Wisconsin and must be used by all family child care programs licensed in Wisconsin. Child Care Services has many important forms available online for easy access. Child Care and the Novel Coronavirus (COVID-19) Closure information around child care and the novel coronavirus in your state *Child care programs may provide services, provided that all updated state and local guidelines are being followed. These teachers must hold an Early Childhood or PK teacher license. Any questions about Document Sales should be directed to Document Sales and Distribution at 608-243-2441. Types of regulated child care include: Certified Care (3 or fewer children under age 7 in care) Licensed Family Child Care (up to 8 children under age 7) Grace Lutheran Child Care Center Facility Address (Street, City, State, Zip Code) Telephone Number Facility ID 11266 State Highway 10 W Marshfield, WI 54449 (715) 676-2213 1001552 Instructions - Licensee Post the Compliance Statement near the license in accordance with s.48.657, Wis. Stats. Certified Care (3 or fewer children under age 7 in care) Licensed Family Child Care (up to 8 children under age 7) Licensed Group Child Care (9 or more children under age 7) Day Camp (seasonal program for 4 or more children ages 3 & up) Mission:To support working parents by protecting the health and safety of children in child care programs we oversee.This is accomplished by: Establishing and assessing health and safety standards. Certified Family Child Care: Certification is a voluntary form of regulation for individuals who care for 1 to 3 children under age 7. Most states allow some child care providers to be exempt from child care licensing laws. Wisconsin child care certification One course must be in early childhood education and the other course must be about operating a child care business. DCF 56 (Foster Home Licensing), Adoption Investigation Report to Circuit Court, Adoption Assistance High School Information, Child Record Checklist - Child Care Centers, Request for Confirmation of Child's Indian Status, Notice of Involuntary Child Custody Proceeding Involving an Indian Child, Staff Orientation Checklist - Group Child Care Centers, Volunteer Training Confirmation - Group Child Care Centers, Request for Emergency Detention or Pick-up Orders, Child to be Removed from Foster Home, Treatment Foster Home, or Group Home, Kinship Care Referral for Child Support Services, inship Care Referral for Child Support Services, Continuing Education Record - Independent Reading-Video Viewing, Out-of-Home Care Support Plan Evaluation / Revision, Staff Continuing Training Record Child Welfare Programs, Exceptions Panel Second License Application, Adolescent Assessment / Placement Stabilization Center Admission, Adoptive Placement Checklist - Child Placing Agencies International, Adoption Assistance Agreement Amendment Payment Reduction - Termination, Residential Care Center Policy / Procedure Checklist, Residential Care Center Child Abuse and Neglect Reporting and Confidentiality Responsibilities, Residential Care Center Statutorily Reportable Death, Electronic Deposit Authorization for Provider Payment, Notice to Foster Parents Regarding Confidentiality of Records, Out-of-Home Placement Notification or Recommended Placement Notification, DCF Scholarship Application for Youth in Out-of-Home Care, Foster Parent Insurance Program - Damage Claim Checklist, Kinship Care Denial of Payment and Appeal Rights, Foster Care or Treatment Foster Care License Revocation, Initial Licensing Checklist - Family Child Care Centers, Independent Living Services Checklist (Optional), Staff Orientation Checklist - Family Child Care Centers, Notice Of County's Intent Not to Pursue Extension of Dispositional Order, Adoptive Placement Checklist - Child Placing Agency - Domestic, Adoption Portfolio Contents Acknowledgement, Infant Relinquishment - Questions About You and the Infant, Notification of Child's Removal from Foster Home, Notification of Child's Removal From Foster Home - Child in Home for Six Months or More - Emergency, Medication Administration Record - Group Homes for Children, Building Inspection Report - Licensed Child Care Centers and Certified School-Age Programs, Policy Checklist - Family Child Care Centers, Subsidized Guardianship High School Information, Subsidized Guardianship Checklist / Routing, Policy Procedure Checklist - Group Homes for Children, Medical Services Consent - Child Welfare Facilities, Staff Volunteer Orientation Documentation - Group Homes, Resident Orientation Documentation - Group Home, Intake Information Group Home Resident Under 6 Years of Age, Fire Safety and Emergency Response Documentation Residential Care Centers for Children and Youth, Fire Safety and Emergency Response Documentation - Group Homes, Fire Safety and Emergency Response Documentation - Shelter Care Facility, Notice of Client Change of County Residence, Advance Notice of Termination of Adoption Assistance, Notice of Decision on Adoption Assistance Eligibility Status, Advance Notice of Termination of Subsidized Guardianship at Age 18, Voluntary Placement Agreement for an Indian Child, Documentation of Caseworker Face to Face Contact with Child, Wisconsin Works (W-2) Overpayment Recoupment Notice, Wisconsin Works (W-2) Repayment Agreement, Child Care Cash Collections/Repayments CARS Profile #9006, School Enrollment and Attendance Information Release, Request for Permission to Inspect Monthly Wisconsin Works (W-2) Report, Refugee Cash Assistance Eligibility - Notice of Decision, Refugee Cash Assistance Ineligibility - Notice of Decision, Refugee Cash Assistance Ineligibility - Notice of Decision - Bosnian, Refugee Cash Assistance Ineligibility - Notice of Decision - Hmong, Refugee Cash Assistance Ineligibility - Notice of Decision - Somali, Refugee Cash Assistance Ineligibility - Notice of Decision - Russian, Refugee Cash Assistance Termination - Notice of Decision, Refugee Cash Assistance Work Programs - Notice of Referral, Refugee Cash Assistance Sanctions - Notice of Decision, Refugee Cash Assistance (RCA) Participation Agreement, Refugee Case Assistance (RCA)Participations Agreement, Refugee Cash Assistance (RCA)Participation Agreement, Refugee Cash Assistance Repayment Agreement, Sample Refugee Cash Assistance Overpayment Notice Letter, Guardian's Application for Child Support Services, Parent's Application for Child Support Services, Request for Privacy Protection (Child Support), Confidential Information Release Authorization (Child Support), Request for Re-Issuance of a Stale-Dated Check (Child Support), Request for Abandoned Funds (Child Support), Wisconsin Works (W-2) Participation Agreement, Authorization for Disclosure of Confidential Information, Request for a Wisconsin Works (W-2) Fact-Finding Review, Wisconsin Works (W-2) Work Training Site Agreement, Domestic Abuse Screen Self-Administered Version, Wisconsin Works (W-2) and Related Programs Registration, Emergency Assistance Application - Part 1, Emergency Assistance Application - Part 1, Wisconsin Works (W-2) and Related Programs Authorization of Participant Representation, Household Budget Worksheet for Wisconsin Works (W-2), Wisconsin Works (W-2) and Related Programs Application, Child Care (CC) Client Overpayment Notice, Child Enrollment and Health History - Certified Child Care, Regulatory Agency Approval/Acknowledgement to Operate Child Care Business, Regulatory Agency Approval / Acknowledgement to Operate Child Care Business, Child Care Online Systems (CCPP/CSAW) Access Request for Agency Staff Only, Certification Application-Family and In-Home Child Care Programs, Standards and Checklist-Family/In-Home Child Care Certification, Amendment Request to Extend Care to Residents 18 years of Age and over, but under 21 years of age, Application and Affidavit for Professional License, Application and Affidavit for Recreational License, Initial Licensing Checklist - Group Child Care Centers, Child Record Checklist - Certified Child Care, Multipurpose Home Study Report - Couples / Single (With Instructions), Multipurpose Home Study Update / Recertification (With Instructions), Multipurpose Home Study Update / Recertification, Multipurpose Home Study Report - Couples / Single, Acceptance of Child Care Payments - DCF 201 Statement of Understanding and Agreement, Staff Continuing Education Record - Child Care Centers, Staff Health Report - Child Care Provider, Other Activity Notification/Permission - Child Care Centers, Alternate Arrival/Release Agreement - Child Care Centers, Staff Record Checklist - Group Child Care Centers Confidential - Do Not Post, Staff Record Checklist - Family Child Care Centers, Written Translation Professional Services Contract Request for Services, In-Person Interpreter Professional Services Contract Request for Services, Voluntary Transition to Independent Living Agreement, Voluntary Placement Agreement for Shelter Care, Request by Shelter Care Facility to Accept Voluntary Placements and/or to Provide Respite Care Services, Supervised Independent Living (SIL) Rate Setting, Residential Care Center (RCC) Extend Care Funding Application, Notice of Initial Determination of Substantiated Child Maltreatment and Right to Request a Review, Scheduled Review of the Initial Determination of Child Abuse and/or Neglect, Notice of Final Determination of Child Abuse and/or Neglect and Right to Request an Appeal-Review Occurred, Notice of Final Determination of Child Abuse and/or Neglect and Right to Request an Appeal-No Response, Notice of Final Determination of Child Abuse and/or Neglect and Right to Request an Appeal-Review Occurred, Licensor Guide to the Online Foster Parent Independent Living Training, Family History Questionnaire Medical / Genetic, Family History Questionnaire Medical / Genetic - Pregnancy and Delivery Information, Employer Confirmation of Earnings and Hours for Client, Employer Confirmation of Earnings and Hours for Provider, Special Needs Adoption Program (SNAP) Referral Checklist, Extended Relative and Non-Relative Search and Engagement Consent, Request for Child Protective Services Background Check for Certain Purposes, Public Adoptions Request for Specialized Services or Residential Care Center Placements, Request for Taxpayer Identification Number and Certification, Child Care Agency Annual Summary: Certification Contract Function Only, 2017 DCF / DFES Worker's Compensation Coverage Application, 2017 DCF / DFES Worker's Compensation (Declines Coverage), Performance Outcome Payment Claim Denial Decision Appeal Form, Subsidized Guardianship of Children with Special Needs One time Expense Reimbursement, Child Welfare Request for Exception - Age, Wisconsin Works Trial Employment Match Program - Employer Agreement, Birth Parent Request for Adoptee's Identity, Health and Safety Checklist - License Exempt Program  DCF 251, Information Required to Monitor School-Run, License-Exempt Child Care Centers, External SPARC Sign In Authorization Request, Report to the Court on the Adoption Investigation, Reasonable and Prudent Parent Standard Review, Reasonable Prudent Parenting Decision Record, Child Welfare Licensing Shelter Care Extension, Access Request - WEBi Foodshare & Automated Case Directory, Access Request - WEBi Employment Programs, Staff Record Checklist - License Exempt Child Care. 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