Form Dcf F Cfs0061 E – Fill Out and Use This PDF

The DCF F CFS0061 E form serves as a comprehensive intake document designed specifically for children under the age of 2 in child care centers, mandated by the Department of Children and Families (DCF) for family child care centers and certified providers. It collects vital information to individualize care programs and requires parental completion before the child's first day. Tailored to optimize child care practices, this form plays a pivotal role in meeting both mandatory and voluntary compliance standards.

To ensure your child receives the best care tailored to their needs, click the button below to fill out the DCF F CFS0061 E form.

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Form Dcf F Cfs0061 E PDF Details

Ensuring that children under 2 years old receive appropriate and individualized care in child care centers demands meticulous planning and information gathering, a task significantly eased by the Department of Children and Families (DCF) through its Dcf F Cfs0061 E form. This mandatory document for family child care centers, under DCF 250.09(1)(c)1, and certified providers, adhering to 202.08(12)(g), plays a crucial role in noncompliance avoidance. While group child care centers are not obliged but encouraged to utilize this form, as it aligns with DCF 251.09(1)(am), its primary aim is to gather detailed information about the children under age 2. This information aids child care workers in tailoring care programs specific to each child's needs, covering aspects from health conditions, feeding schedules, sleep patterns, to information on diapering or toileting, verbal communication, comforting mechanisms, self-expression, and both physical and social development. Required to be completed by a parent and kept on file prior to the child's first attendance, the form also facilitates regular updates, ensuring care providers are informed of any changes. By capturing extensive details, including health history, emergency care plans, preferences in meals, sleep positions, toilet training, language spoken at home, and comfort routines, the form underscores a holistic approach to child care, aiming for a constructive and nurturing environment.

Question	Answer
Form Name	Form Dcf F Cfs0061 E
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	dcf_f_cfs0061_e intake for child under 2 years form

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DEPARTMENT OF CHILDREN AND FAMILIES

Division of Early Care and Education

INTAKE FOR CHILD UNDER 2 YEARS – CHILD CARE CENTERS

Use of form: This form is mandatory for family child care centers to comply with DCF 250.09(1)(c)1. and for certified providers to comply with 202.08(12)(g). Failure to comply may result in issuance of a noncompliance statement. This form is voluntary for group child care centers; however, it meets the requirements of DCF 251.09(1)(am). This form collects information about children under age 2 in order to aid child care workers in individualizing the program of care for the child in a family or group child care center. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].

Instructions: This form is to be completed by a parent and must be on file at the center prior to a child's first day of attendance. Regular updates can be noted. This form should be kept in the room where care is provided. If additional space is needed, attach a separate sheet.

First Day of Attendance (mm/dd/yyyy)

PARENT / CHILD NAME AND ADDRESS

Name – Child (Last, First, MI)

Nickname (If any)

Birthdate (mm/dd/yyyy)

Name – Parent(s) (Last, First, MI)

Telephone Number – Home

Address – Parent(s) (Street, City, State, Zip Code)

HEALTH Note: Health conditions that may affect the care of the child must be recorded on the department’s form, Health History and Emergency Care Plan. The form should be shared with any person who provides care for the child.

Child has frequent colds, ear infections, colic, etc. – Describe.

UPDATES

MEALS

Current feeding schedule						Length of time on current schedule

Food type
Formula		Strained	Junior	Table	Milk type – Specify:

New food timetable

When eating, child is –
Held in lap		In highchair	Other – Specify:

Feeds self
Yes	No	If "Yes", uses:	Spoon	Fork	Hands

Special feeding problems
Yes	No	If "Yes" – Specify:

Food allergies
Yes	No	If "Yes" – Specify:

Favorite foods – Specify.

Refused foods – Specify.

UPDATES

DCF-F-CFS0061-E (R. 01/2009)

Page 1 of 4

SLEEP

Current sleep schedule				Length of time on current schedule

Falls asleep easily			Mood upon awakening – Describe.
Yes	No

Takes favorite toy(s) to bed – child over age 1 year
Yes	No	If "Yes" – list toy(s):

Sleep position – child under age 1 year

Note: Children under age 1 year must be placed to sleep on their back unless a written statement from the child's physician is attached.

Back for children under age 1 year		Side or stomach (physician statement attached)

Sleep position – child over age 1 year
Back	Side or stomach

UPDATES

DIAPERING / TOILETING

Diaper – type					Diapers provided by parent
Cloth		Disposable			Yes	No

Plastic pants used
Always		Never	Sometimes	If "Sometimes" – Specify:

Highly sensitive skin					Frequent diaper rash
Yes	No				Yes	No

Lotions, powders or salves used
Yes	No	If "Yes", product name(s) – Specify:

Toilet training attempted
Yes	No	If "Yes", describe routine.

Type of toilet seat used at home
Potty chair		Special toilet seat		Regular toilet seat

Regular bowel movements
Yes	No	How often.			Time(s) of day:

Toileting problems
Yes	No	If "Yes" – Describe.

UPDATES

VERBAL COMMUNICATION

Family speaks what language – Specify.

English	Other	If "Other" – Specify:

Age child began talking			Child speaks in
			Words	Sentences

Words used to describe special needs – Specify.

UPDATES

Page 2 of 4

COMFORTING

Does child have a fussy time?

Yes No If "Yes" – Specify time.

How is fussy time handled?

Child likes to be:

Held Sung to Rocked Read to Other – Specify:

Special things you say or do to comfort child.

UPDATES

SELF-EXPRESSION

What causes your child to feel angry or frustrated?

What frightens your child and how is it shown?

How does your child express feelings of happiness, enjoyment, etc.?

Additional comments

UPDATES

PHYSICAL AND SOCIAL DEVELOPMENT

Is your child able to – (Check all that apply)

Sit up alone		Pull up	Crawl	Walk holding on	Walk without support

Yes	No	Is your child used to playmates?

Comments

UPDATES

Page 3 of 4

MISCELLANEOUS

Child's indoor favorite toys and activities – Specify.

Child's outdoor favorite toys and activities – Specify.

By providing complete information about your child, you will be assisting staff in creating a positive experience for him / her while in care. List any information about your child's habits, abilities or personality that you feel will be helpful to the staff while caring for your child.

UPDATES

SIGNATURE – Parent or Guardian

Date Signed

Page 4 of 4

How to Edit Form Dcf F Cfs0061 E Online for Free

You could fill out Form Dcf F Cfs0061 E instantly using our PDFinity® PDF editor. To make our editor better and simpler to work with, we consistently work on new features, with our users' feedback in mind. For anyone who is seeking to begin, this is what it takes:

Step 1: First, open the pdf editor by clicking the "Get Form Button" above on this page.

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It will be easy to complete the document using this helpful guide! This is what you want to do:

1. The Form Dcf F Cfs0061 E necessitates particular information to be typed in. Make certain the subsequent fields are filled out:

Part # 1 of submitting Form Dcf F Cfs0061 E

2. The third part would be to fill in these blank fields: Length of time on current schedule, MEALS Current feeding schedule, Food type, Formula, Strained, Junior, Table, Milk type Specify, New food timetable When eating, Held in lap, In highchair, Other Specify, Feeds self, Yes, and If Yes uses.

Table, Milk type Specify, and Other Specify of Form Dcf F Cfs0061 E

3. In this particular stage, have a look at SLEEP Current sleep schedule, Falls asleep easily, Mood upon awakening Describe, Yes, Takes favorite toys to bed child, Yes, If Yes list toys, Length of time on current schedule, Sleep position child under age, Back for children under age year, Back, Side or stomach, UPDATES, DIAPERING TOILETING Diaper type, and Cloth. All of these are required to be taken care of with highest focus on detail.

Form Dcf F Cfs0061 E writing process shown (portion 3)

4. To move onward, this fourth part involves completing a couple of form blanks. Included in these are Yes, If Yes product names Specify, Toilet training attempted, Yes, If Yes describe routine, Type of toilet seat used at home, Potty chair, Special toilet seat, Regular toilet seat, Regular bowel movements, Yes, No How often, Toileting problems, Yes, and If Yes Describe, which you'll find key to moving forward with this document.

Form Dcf F Cfs0061 E conclusion process shown (stage 4)

5. Now, the following final part is precisely what you will need to finish before finalizing the PDF. The blanks at issue include the next: COMFORTING Does child have a fussy, Yes, If Yes Specify time, How is fussy time handled, Child likes to be, Held, Sung to, Rocked, Read to, Other Specify, Special things you say or do to, UPDATES, SELFEXPRESSION What causes your, and What frightens your child and how.

The best way to prepare Form Dcf F Cfs0061 E portion 5

A lot of people generally make some mistakes when filling out Held in this section. Be certain to reread what you type in here.

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Form Dcf F Cfs0061 E – Fill Out and Use This PDF

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