Daycare License Application Form - Idaho

This "Daycare License Application Form" is a part of the paperwork released by the Idaho Department of Health and Welfare specifically for Idaho residents.

The latest fillable version of the document was released on April 6, 2018 and can be downloaded through the link below or found through the department's forms library.

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Daycare Licensing Instructions and Application
Rev 04/06/2018
NOTE:
If you have problems viewing this application, download a current version of Adobe Reader:
https://get.adobe.com/reader/.
1. Complete all fields.
How to Submit the form
2. Return the completed form using the information provided below.
3. Review Daycare Licensing requirements prior to submitting the application.
Email:
vs@idahoaeyc.org
Contact Information
Mail:
IdahoSTARS - Vendor Specialists
4355 W. Emerald St., Suite 250
Boise, ID 83706
Fax: 208-345-2973
The Vendor Specialists with IdahoSTARS collect the documentation and are available to assist the
Who to Contact
applicant through the state daycare licensing process. Dial 2-1-1 the Idaho CareLine. Ask to
speak with a vendor specialist for daycare licensing.
New applicants have six (6) months to complete the application process below:
New Application
▪ Start date of application is the date the completed and signed application is received by
IdahoSTARS.
▪ All required documentation is to be submitted at least 45 days prior to the six-month deadline to
allow sufficient time for processing. Delays in submitting paperwork may result in insufficient
time to process paperwork or give the applicant insufficient time to address any deficiencies.
▪ Applications not completed in 6 months may be denied. Applicants who have been denied are
prohibited from reapplying for a daycare license for 1 year from the date of denial.
If you are currently licensed and need to renew, complete the process below:
Renewal Application
▪ All required documentation is to be submitted at least 45 days prior to the expiration date of
the current daycare license. Delays in submitting paperwork may result in insufficient time to
process paperwork or give the applicant insufficient time to address any deficiencies.
▪ Renewal applications not completed by the license expiration date may be terminated.
Applicants who have been terminated may not operate a center or group facility until a new
application process has been completed and the appropriate daycare license has been issued.
Daycare Licensing information, including city-county requirements, training information, records
Additional Information
requirements, links to resources, forms, and how to file a complaint, can be found online at the
Daycare Licensing website:
http://healthandwelfare.idaho.gov/Children/ChildCareAssistance/DaycareLicensing.aspx.
Daycare Licensing Requirements
Check each box when completed:
Criminal History and Background Clearances - All individuals required to have a criminal history and background check must
obtain a clearance from the Department of Health and Welfare's Criminal History Unit. There is no need to submit copies, as each
clearance status is verified directly with the Criminal History Unit.
Individuals 13-17 years of age will additionally complete a check of Juvenile Justice Records. The form and instructions are
included in the packet.
Information on completing a criminal history and background check though the Criminal History Unit, and how to register as an
employer is available online at:
https://chu.dhw.idaho.gov.
Compliance with City/County Ordinances - Submit proof of compliance with local ordinances. Examples: Special Use Permit, Home
Occupation Certificate, Business License, or a letter from your city or county stating compliance. Please contact your local clerk's office
to verify requirements.
Proof of Insurance - Submit proof of current fire and liability insurance coverage for the daycare.
Pediatric CPR/First Aid - Submit proof of current certifications. At least one adult staff, certified in pediatric rescue breathing, infant-
child CPR, and pediatric first aid treatment, must be present at all times (including during transportation). Online courses are not
accepted.
Fire Safety Inspection - Submit a recently completed and passed Fire Safety Inspection for State Daycare Licensing. Occupant Load
must be included on form.
Complete Required Training Hours (Centers Only) - IdahoSTARS will notify you if additional documentation is required.
Four (4) hours of training must be completed every 12 months after the staff members date of hire.
CPR/First Aid training does not count toward the annual training requirement.
Health & Safety Inspection - IdahoSTARS will request the health inspection at the appropriate time.
Licensing Fee - The Health District will contact you regarding payment collection.
Page 1 of 3
Daycare Licensing Instructions and Application
Rev 04/06/2018
NOTE:
If you have problems viewing this application, download a current version of Adobe Reader:
https://get.adobe.com/reader/.
1. Complete all fields.
How to Submit the form
2. Return the completed form using the information provided below.
3. Review Daycare Licensing requirements prior to submitting the application.
Email:
vs@idahoaeyc.org
Contact Information
Mail:
IdahoSTARS - Vendor Specialists
4355 W. Emerald St., Suite 250
Boise, ID 83706
Fax: 208-345-2973
The Vendor Specialists with IdahoSTARS collect the documentation and are available to assist the
Who to Contact
applicant through the state daycare licensing process. Dial 2-1-1 the Idaho CareLine. Ask to
speak with a vendor specialist for daycare licensing.
New applicants have six (6) months to complete the application process below:
New Application
▪ Start date of application is the date the completed and signed application is received by
IdahoSTARS.
▪ All required documentation is to be submitted at least 45 days prior to the six-month deadline to
allow sufficient time for processing. Delays in submitting paperwork may result in insufficient
time to process paperwork or give the applicant insufficient time to address any deficiencies.
▪ Applications not completed in 6 months may be denied. Applicants who have been denied are
prohibited from reapplying for a daycare license for 1 year from the date of denial.
If you are currently licensed and need to renew, complete the process below:
Renewal Application
▪ All required documentation is to be submitted at least 45 days prior to the expiration date of
the current daycare license. Delays in submitting paperwork may result in insufficient time to
process paperwork or give the applicant insufficient time to address any deficiencies.
▪ Renewal applications not completed by the license expiration date may be terminated.
Applicants who have been terminated may not operate a center or group facility until a new
application process has been completed and the appropriate daycare license has been issued.
Daycare Licensing information, including city-county requirements, training information, records
Additional Information
requirements, links to resources, forms, and how to file a complaint, can be found online at the
Daycare Licensing website:
http://healthandwelfare.idaho.gov/Children/ChildCareAssistance/DaycareLicensing.aspx.
Daycare Licensing Requirements
Check each box when completed:
Criminal History and Background Clearances - All individuals required to have a criminal history and background check must
obtain a clearance from the Department of Health and Welfare's Criminal History Unit. There is no need to submit copies, as each
clearance status is verified directly with the Criminal History Unit.
Individuals 13-17 years of age will additionally complete a check of Juvenile Justice Records. The form and instructions are
included in the packet.
Information on completing a criminal history and background check though the Criminal History Unit, and how to register as an
employer is available online at:
https://chu.dhw.idaho.gov.
Compliance with City/County Ordinances - Submit proof of compliance with local ordinances. Examples: Special Use Permit, Home
Occupation Certificate, Business License, or a letter from your city or county stating compliance. Please contact your local clerk's office
to verify requirements.
Proof of Insurance - Submit proof of current fire and liability insurance coverage for the daycare.
Pediatric CPR/First Aid - Submit proof of current certifications. At least one adult staff, certified in pediatric rescue breathing, infant-
child CPR, and pediatric first aid treatment, must be present at all times (including during transportation). Online courses are not
accepted.
Fire Safety Inspection - Submit a recently completed and passed Fire Safety Inspection for State Daycare Licensing. Occupant Load
must be included on form.
Complete Required Training Hours (Centers Only) - IdahoSTARS will notify you if additional documentation is required.
Four (4) hours of training must be completed every 12 months after the staff members date of hire.
CPR/First Aid training does not count toward the annual training requirement.
Health & Safety Inspection - IdahoSTARS will request the health inspection at the appropriate time.
Licensing Fee - The Health District will contact you regarding payment collection.
Page 1 of 3
Daycare Licensing Instructions and Application,
continued...
Application Type
NEW APPLICATION
RENEWAL APPLICATION
Large Daycare Center 26 or more children
Small Daycare Center up to 25 children
non-refundable license application fee $325
non-refundable license application fee $250
Group Daycare Facility up to 12 children
FAMILY Daycare Home up to 6 children
non-refundable license application fee $100
non-refundable license application fee $100
An OCCUPANT LOAD is the maximum number of individuals (children and adults) to occupy the areas used for daycare
purposes.
The Maximum Number of Children In Attendance can be limited by occupant load, type of license, the number of your own
children present, and local requirements.
Facility Information
Facility Name
Business Name (if different)
Owner(s)
Primary Business Contact
Phone
Email
Physical Address
City
State
Zip Code
County
Mailing Name and Address (if different)
City
State
Zip code
County
List of Individuals on Premises
All Owners, Operators and Child Care Facility Staff who provide direct care to children.
All Other Individuals (age 13 and older) who have unsupervised direct contact with children, or are regularly
on the premises (more than 12 hrs. per month), including non-direct care staff, frequent visitors, volunteers, or
any person living at the location where child care takes place.
Do they
Do they
Date of
Date of Hire
provide direct
reside where
Name
Position at Facility
Birth
Month/Year
care to
child care
Month/Year
children?
takes place?
Page 2 of 3
Rev 04/06/2018
Daycare Licensing Instructions and Application,
continued...
List of individuals on Premises, continued
Do they
Do they
Date of
Date of Hire
provide direct
reside where
Name
Position at Facility
Birth
Month/Year
care to
child care
Month/Year
children?
takes place?
Review before Submitting Application
Daycare licensing information, including city-county requirements, training information, records requirements, links to
resources, forms, and how to file a complaint, can be found online at the Daycare Licensing website:
http://healthandwelfare.idaho.gov/Children/ChildCareAssistance/DaycareLicensing.aspx.
Certification of Understanding
I hereby apply for a daycare license as indicated above in accordance with Idaho Code Title 39, Chapter 11.
I do hereby state that I have thoroughly read and reviewed the IDAPA 16.06.02 Rules Governing Standards for Child Care
Licensing, and I am prepared to comply with all of its provisions.
I understand that my facility must, at all times, remain in compliance with the fire, health and safety standards, and criminal
history and background-check requirements.
I understand that I am to disclose, by written statement, any revocation or other disciplinary action taken, or in the process of
being taken, against myself, as a daycare provider in Idaho, or any other jurisdiction.
I understand that this document serves as the formal request upon which a decision to issue me a daycare license will be based. I
agree, for the purpose of determining compliance with daycare licensing rules established by the Department of Health and
Welfare and Idaho State licensing laws, to allow the Department access to the premises for re-inspection at any time during the
licensing period.
I authorize investigation of all statements contained herein, and understand that misrepresentation or omission of facts may
result in denial of my application.
I do hereby state that the information provided in this application is true and correct to the best of my knowledge.
Signature (required)
Under penalty of perjury, I swear or affirm the information I have provided is true and complete.
Signature - Owner (or) Legally Responsible Representative
Date
Signature - Owner (or) Legally Responsible Representative
Date
Rev 04/06/2018
Page 3 of 3

Download Daycare License Application Form - Idaho

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