Click here to access the Pennsylvania Department of Public Welfare's website and these child day care forms.

Child Health Assessment Form (CY-51)
Registration Law (CY-117)
Day Care Staff Data Sheet (CY-142)
Agreement Day Care Facility (CY-321)
Staff Health Assessment (CY-322)
Medication Log (CY-862)
Verbal Request for Release of Child (CY-863)
Fire Drill Log (CY-864)
Incident Report Form (CY-866)
Emergency Contact/Parental Consent Form (CY-867)
Pennsylvania Child Abuse History Clearance Form (CY-113)
Pennsylvania Child Abuse History Clearance Forms – Instructions
Pennsylvania State Police Request for Criminal Record Check Form (SP 4-184)

If you have questions regarding these forms or publications or their use, please direct them to the appropriate DPW Regional Child Day Care Office:

Central Region Child Day Care Office
(717) 772-7078 or (800) 222-2117
Northeast Region Child Day Care Office
(570) 963-4371 or (800) 222-2108
Southeast Region Child Day Care Office
(215) 560-2541 or (800) 346-2929
Western Region Child Day Care Office
(412) 565-5183 or (800) 222-2149