Forms & Publications

Licensed Child Care Program Record Check Form
This record check form must be submitted on all staff in a licensed child care program in Vermont. In addition to the record check form please include a copy of the record check census form with the record checks.

Licensed Child Care Program Record Check Form - Multi-site Programs
This record check form must be submitted on all staff in a licensed child care program in Vermont. This form is only for program that have multiple locations with staff that work in several locations. In addition to the record check form please include a copy of the record check census form with the record checks.

Registered Child Care Program Record Check Form
This record check form must be submitted on all staff and household members in a registered child care program in Vermont.

Registered Child Care Home Self-Assessment Form
This form is used by people that are applying to become a registered child care home as a self assessment.

Child Enrollment Form [sample]
This is a sample form programs may use for enrollment to their program. This form contains all the information that is required by licensing regulations.

Child Care Sign In and Out Sheet [sample]

This is a sample form programs may use to record when children come in or leave their program on a daily basis.

Immunization Checklist [Link to Vermont Department of Health]
Documentation of immunizations for each child enrolled in child care is required. This is an optional form for assessing a child’s immunization records .  Acceptable documentation of immunization includes:

  • A record from the primary care provider, including an electronic health record.
  • A record from any public health department.
  • A record from Vermont or another state’s Immunization Registry.
  • A laboratory report of a titer indicating evidence of immunity to each disease for which immunization is required.

Immunization Exemption and Parent Education Forms
Children shall be immunized appropriately for their age, unless they have religious, philosophical/moral or medical exceptions. If the child has an exemption for any immunization the appropriate forms must be filled out by the parent and kept on record. Children with medical exemptions should have a Medical Exemption Form kept on file. For children with religious or philosopical exemptions both the Required Parent Education  form and the Religious and Philosophical Exemption Form should be kept on file

Medication Permission Form [sample]
Prior to administering any medication to children, providers need to have permission from the parent. Please refer to the child care regulations about specific requirements for administering medication.

Topical Lotion/Medication Permission Form [sample]

Prior to applying any topical lotion or topical medication to children, providers need to have permission from the parent. Please refer to the child care regulations for specific requirements for administering medication.

Lead Paint:

In 1996, the Vermont Legislature passed Act 165, Vermont’s lead law, an act to prevent childhood lead poisoning in older rental housing and child care facilities (built anytime before 1979). The law requires that landlords of older buildings and child care facility operators take steps to help prevent children from being exposed to lead. Learn more about lead poisoning and requirements for child care programs. The Department of Health has a specific form that child care facilities must complete if they are located in a building that was built prior to 1978.