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 at:
Clay County Social Services
715 11th Street N.
Suite 502
Moorhead, MN 56560
- Accident Report (PDF)
- Admission and Arrangement (PDF)
- Alcohol / Drug Use Policy (PDF)
- Allergy Information Form (PDF)
- Application – Family Child Care (PDF) (new and renewing providers)
- Certificate of Compliance - Minnesota Workers' Compensation Law (PDF)
- Child Care Activity / Travel Authorization (PDF)
- Child Care Reporting / Mandated Reporter Form (PDF)
- Consent for Emergency Medical / Dental (PDF)
- Crib Monthly Inspection Form (PDF)
- Crib Guide 2011 (PDF)
- Emergency Plan (PDF)
- Expedited Correction Order (PDF)
- Field Trip Permission Form (PDF)
- Fire and Storm Drill Log (PDF)
- Fire Marshal Permission Form for Rental Property (PDF)
- Floor and Escape Plan (PDF)
- Furnace Inspection (PDF)
- Immunization Form (PDF)
- Infant Rolling (PDF)
- Liability Insurance Form (PDF)
- Licensing Requirement Dispute (PDF)
- Mandated Reporter Policy (PDF)
- Notice of Privacy Rights (PDF)
- Parent Consent for Swaddling Infant (PDF)
- Permission to Administer Medication Form (PDF)
- Permission to Administer Over the Counter Items (PDF)
- Physician Directive for Alternative Infant Sleep Positions (PDF)
- Physician's Report (PDF)
- Poisonous Plants (PDF)
- Program Grievance Procedure (PDF)
- Provider Policy Form (PDF)
- Requirements for Helpers / Subs / Second Adult (PDF)
- Rule Summary for Parents (PDF)
- Substitute Hours Tracking (PDF)
- SUIDS, Abusive Head Trauma, and Passenger Restraint Training Log (PDF) (optional form)
- Variance Policy & Procedure (PDF)
- Variance Request (PDF)
- Variance Request Extended Use of Substitute (PDF)
- Wading Pool Permission Form (PDF)
- Wading Pool Fact Sheet (PDF)
- Worksheet for Independent Study (PDF)