Residential Child Care Programs
Residential Child Care Rules
- Final He-C 4001 Residential Child Care Program Licensing Rules
- Table of Contents
- Appendix A Reportable Diseases
- Appendix B
Residential Child Care Licensing Applications & Forms
Package 1 - Application for Residential Child Care Program License
Licensure for a residential child care program begins with completion of an application package. Package 1 below includes copies of all the required items for a residential child care program license application. All licensing materials must be submitted together in one package. An application package which is missing any of the required items will be returned to the applicant.
- Application for Residential Child Care Licensing
- Residential Child Care Personnel Health
- Criminal History Record Information Authorization – CCLU 1-A
- Health Officer Inspection Report
- Household and Personnel Form – CCLU 1-B
- NH State Fire Code Compliance Report
- Residential Program Sworn Statement
- Zoning Verification
Package 2 - Residential Child Care Program License Sample Packet Forms & Samples Formats
- Certificate of Religious Exemption-Immunizations
- Certificate of Religious Exemption- Physical Examination
- Residential Child Care Personnel Health Form
- Residential Child Care Personnel Information
- Emergency Plan
- Emergency Procedures
- Fire Drill Log
- Frequently Asked Questions (FAQ) on Fingerprints for Residential Child Care Programs
- Incident Report
For original copies of the sample form listed above, call the Child Care Licensing Unit at (603) 271-9025.
Note: 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.
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