Child Care Forms

Child Care Forms (all forms are PDF downloads):

Application for Certificate of Compliance for Center Group and Family 
CPSL-Provisional Hiring Disclosure Statement
Child Care Employment Verification Form
CD 208 - Child Service Report
CD 51 (formerly CY 51) Child Health Assessment
CD-322 - Staff Health Assessment
CY 142 - Day Care Staff 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

 * You can now submit your Pennsylvania Child Abuse History Clearance Request online.

Additional questions may be directed to the appropriate Regional Office of Child Development:

North Central Region: Harrisburg (717) 772-7078 or (800) 222-2117 
Scranton (570-963-4371 or (800) 222-2108
Southeast Region (215) 560-2541 or (800) 346-2929
Western Region (412) 565-5183 or (800) 222-2149

*FOR QUESTIONS REGARDING YOUR PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE APPLICATION, CONTACT CHILDLINE AT 1-877-371-5422.