Get Dhs 6114 Form Pdf

Completing the Dhs 6114 Form Pdf online can streamline the process of providing essential information for family child care admissions. This guide offers clear and concise instructions to ensure that you can confidently fill out the form correctly.

Follow the steps to complete the Dhs 6114 Form Pdf online.

1. Click the ‘Get Form’ button to obtain the form and open it in a suitable editing tool.
2. Begin by filling out the 'Child Information' section. Enter the child’s last name, first name, address, birthdate, city, state, date enrolled in care, and zip code.
3. Complete the 'Parent or Guardian #1' section. Provide the last name, first name, address of employer, place of employment with work phone number, city, email, home phone, and if applicable, an alternative address. Also include zip code and cell phone number.
4. Fill in the 'Parent or Guardian #2' section similarly, including all required contact information.
5. Enter the 'Emergency Contact for Child' section. Provide full information for at least one contact who is authorized to pick up the child, including their relationship and phone number.
6. Complete the 'Emergency Information for Child' section by providing the name and address of a hospital and a physician along with the dentist's information.
7. Under 'Child Care Provider', fill in the name, license number, and address of the provider.
8. Outline the 'Arrangements' by detailing financial arrangements, services provided (including days, hours, and meals), any special conditions, and if allergies exist.
9. Respond to the 'Liability Insurance Notification' section by selecting the appropriate option regarding liability insurance coverage.
10. Provide any necessary permissions, including transportation authorization and acknowledgment of the emergency preparedness plan.
11. Finally, ensure all parties have signed and dated the form, confirming compliance with the required arrangements and authorizations.
12. Once completed, save any changes, and then choose to download, print, or share the form as needed.

Start filling out your Dhs 6114 Form Pdf online today!