Application for Child Care Program or Residential Child Care Program License
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.
- Application Instructions and Cover Letter
- Application for Child Care Licensing
- Child Care Personnel Health
- Criminal Record Release Authorization - State Only
- Criminal Record Release Authorization - FBI Fingerprints
- Household and Personnel List - Age 17 and older
- Household and Personnel List - Age 10 to 16 years
- Zoning Verification
- Health Officer Report
- Life Safety Compliance Report
- Residential Program Sworn Statement
For original copies of the sample forms listed above, call the Child Care Licensing Unit at (603) 271-9025.
Child Care Program License Sample Packet Forms, Checklists, Administrative Tips-Tools, Sample Formats.
Licensure for a child care program continues with an inspection and achieving compliance with all CCLU rules and statute, 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.
- Authorization to Administer Medication
- Authorization to Allow Child to Leave Supervision
- Authorization to Use Electronic Monitoring
- Certificate of Religious Exemption-Immunizations
- Certificate of Religious Exemption-Physical Examination
- Child Care Personnel Health
- Child Care Personnel Information
- Child Care Registration and Emergency Information
- Children's Attendance Sample
- Combined Staff and Child Attendance Sample
- Criminal Record Release Authorization
- Emergency Plan
- Emergency Procedures
- Family Child Care Business Policy
- Feeding Suggestions for Infants and Toddlers
- Field Trip Authorization-Group
- Field Trip Authorization-Individual
- Field Trip Authorization-Water Activity
- Fire Drill Log
- Health Assessment Form
- Ideas for Lunch Box Meals
- Injury Report
- Playground Safety Self-Inspection Checklist
- Playground Safety Suggestions
- Reminder List
- Staff Attendance Record
- Staff Only Attendance Sample
- Toddler Tales
- Transportation Authorization
- Weekly Menu for Meals
For original copies of the sample form listed above, call the Child Care Licensing Unit at (603) 271-9025.
Some forms in both packages are completed entirely by the applicant; some forms are completed by both the applicant and someone authorized to verify the status of some specific required action, e.g., health department or fire safety inspections. For most may be printed directly from this Web site. However, there are two forms that are multi-part. These forms, referred to as Non Carbon Reproduced (NCR) must be ordered from CCLU; only the NCR version is accepted as part of an application submittal. Samples of these documents are included in Package 1 and are identified as NCR forms.
Adobe Acrobat Reader format. You can download a free reader from Adobe.