Note: The forms found below are available in PDF format.
- Application for Certificate of Compliance: Center, Group, and Family Home
- Disclosure Statement for Child Care Employment
- Disclosure Statement for Child Care Volunteers
- Child Care Employment Verification Form
- CD 208: Child Service Report
- CD 51: Child Health Assessment
- CD 322: Child Care Staff Health Assessment
- CD 355: Documentation of Emergency Plan DeliveryDocumentation of Emergency Plan Delivery | Español
- CD 357: Request For Waiver of Child Care Facility Regulation
- CY 142: Child Care Employee Data Sheet
- CY 321: Day Care Agreement
- CY 862: Medication Log
- CY 863: Verbal Request for Release of Child
- CY 864: Fire Drill Log
- CY 866: Incident Report Form
- CY 867: Emergency Contact/Parental Consent Form
- CY 113: Pennsylvania Child Abuse History Clearance
- CY999: Consent/Release of Information Authorization Form
- SP 4-164: Request for Criminal Record Check
- PW 29A — Day Care Services Enrollment/Attendance Record
- CD 356: Emergency Drill Log
Questions about your PA Child Abuse Clearance application?
Call ChildLine
1-877-371-5422.
You can now submit your your Child Abuse History Clearance request online.
The Pennsylvania Department of Human Services (DHS), which is in part comprised of the Office of Children, Youth, and Families (OCYF) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.