Can't find the form you're looking for or need addtional information? Please contact the Regional Child Development Office nearest you.
- Application for Certificate of Compliance: Center, Group, and Family Home
- Disclosure Statement:Application for Employment, Including Provisional Employment
- 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.