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Family Child Care Licensing

Clay County accepts and processes applications for licensure as a child care provider including inspections, home studies and background checks, and evaluations of prospective licensees.  Clay County Social Services makes recommendations to the Department of Human Services regarding initial or renewal licensure and negative licensing actions such as revocation or suspension.

Licensors

Licensing Packets

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New Provider Licensing Application Packet

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Review Packet

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Re-licensing Packet

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Change of Premise Packet

Licensing Forms

Clay County Social Services makes available several Child Care Licensing Forms for use by Licensed Child Care Providers in Clay County.  Return all required materials to your Licensor.

The Child Care Licensing Forms below are available from the Clay County web site in the Portable Document Format (PDF).  To view and print the PDF version, you need the free Adobe® Acrobat® Reader software.

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Alcohol & Drug Use Policy (PDF:  76 KB / 1 page)

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Background Study Forms (PDF:  139 KB / 2 pages)

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Child Care Accident Report Form (PDF:  191 KB / 1 page)

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Child Care Activity Authorization Form (PDF:  45 KB / 1 page)

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Child Care Program Reporting Notification
(PDF:  81 KB / 1 page)

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Consent for Emergency Medical/Dental Care Form
(PDF:  173 KB / 1 page)

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Field Trip Notification Form (PDF: 10 KB /1 page)

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Fire and Storm Drill Log & Guidelines (PDF:  67 KB / 2 pages)

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Furnace Inspection Form (PDF:  130 KB / 1 page)

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Medication Permission Form (PDF:  20 KB / 1 page)

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Permission to Administer Form (PDF:  23 KB / 1 page)

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Provider's Policies (PDF:  130 KB / 4 pages)

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Request for Fence Variance (PDF:  98 KB / 2 pages)

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Request for Variance Form (PDF:  79 KB / 3 pages)

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SIDS, Shaken Baby & Passenger Restraint Training Log
(PDF:  59 KB / 1 page)

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Worksheet for Independent Study Day Care Training
(PDF:  23 KB / 1 page)

Related forms are available below from web pages outside of the Clay County web site.

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Admission & Arrangements Form (PDF)

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Child Care Immunization Record (PDF)

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Child Care Licensing Rule (PDF)

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Minnesota Fire Codes (PDF)

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Monthly Crib Safety Inspection Form (PDF)

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Notice of Liability Insurance Forms (PDF)

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Notice of Privacy Practices (PDF)

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Parental Consent for Swaddling an Infant (PDF)

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Physician Directive for Alternative Infant Sleep Position (PDF)

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Physician's Report Form (PDF)

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Summary of Minnesota Rules Governing Child Care (PDF)

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Wading Pool Permission Form (PDF)

Helpful Information

Helpful information is available below from web pages outside of the Clay County web site.

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Do You Have a Disability?  (PDF)

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Home Child Care Emergency Plan (PDF)

Adobe and Acrobat Reader are trademarks of Adobe Systems Incorporated.

Social Services | Adult Services | Children & Family Ser. | Fin. Asst. & Child Sup.


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