Office of Program Support,

Bureau of Child Care Licensing

Licensure for a child care program begins with completion of an application package.  Package 1 below includes copies of all the required items for a child care program license application package.  ALL LICENSING MATERIALS MUST BE SUBMITTED TOGETHER IN ONE PACKAGE.  An application package that is missing any of the required items will be returned to the applicant.

Licensure for a child care program continues with an inspection and achieving compliance with all BCCL rules and policies, and maintaining compliance for license renewal.  Package 2 below includes copies of the required items (various forms, checklists, administrative tips and tools, sample formats) to get and  maintain your license to operate a child care program.  

Some forms in both packages are completed entirely by the applicant; some forms are completed by the applicant and someone authorized to verify the status of some specific required action, e.g., health department or fire safety inspections.  For most forms additional copies or duplicates can be Xerox copies.  However, there are a few forms that are multi-part.  These forms, referred to as Non Carbon Reproduced (NCR) must be ordered from BCCL; only the NCR version is accepted as part of an application submittal.  Samples of these documents are included in both packages here and are identified as NCR forms.   

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PACKAGE 1 

Application for Child Care Program or

Residential Child Care Program License

• Application Instructions and Cover Letter (3 pages)
• Application for Child Care Licensing (4 pages) 
• Child Care Personnel Health (1 page) 
• Criminal Record Release Authorization (2 pages) 
• Zoning Verification (1 page)

Required 3 part forms

Call the Bureau of Child Care Licensing at 603-271-4624

• Health Officer Report (NCR form)
• Household and Personnel List (NCR form)
• Life Safety Compliance Report (NCR form) 

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PACKAGE 2

Child Care Program License Sample Packet

(Forms, Checklists, Administrative Tips-Tools, Sample Formats )

• Authorization to Administer Medication (1 page)
• Authorization to Allow Child to Leave Supervision (1 page)
• Authorization to Use Electronic Monitoring (1 page)
• Certificate of Religious Exemption-Immunizations (1 page)
• Certificate of Religious Exemption-Physical Examination (1 page)
• Child Care Personnel Health (1 page)
• Child Care Personnel Information (1 page)
• Child Care Registration and Emergency Information (2 pages)
• Child Health (2 pages)
• Children's Attendance Record (1 page)
• Criminal Record Release Authorization (2 pages)
• Critical Rules Checklist (15 pages)
• Emergency Plan (1 page)
• Family Child Care Business Policy (1 page)
• Feeding Suggestions for Infants and Toddlers (1 page)
• Field Trip Authorization-Group (1 page)
• Field Trip Authorization-Individual (1 page)
• Field Trip Authorization- Water Activity (1 page)
• Fire Drill Log (1 page)
• Ideas for Lunch Box Meals (1 page)
• Injury Report (1 page)
• Playground Safety Self-Inspection Checklist (1 page) 
• Play Ground Safety Suggestions (1 page)
• Reminder List (2 pages)
• Staff Attendance Record (1 page)
• Toddler Tales (1 page)
• Transportation Authorization (1 page)
• Weekly Menu for Meals (1 page)

Required 3 part forms

Call the Bureau of Child Care Licensing at 603-271-4624

• Household and Personnel List (NCR)

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