Pre-K Registration Forms

These forms are intended to be used when registering and enrolling students into a Georgia’s Pre-K Program.

• Appendix A - Parent Acknowledgement
• Appendix A - Parent Acknowledgement - Spanish
• Appendix A - Parent Acknowledgement - Chinese
• Appendix A - Parent Acknowledgement - Korean
• Appendix A - Parent Acknowledgement - Vietnamese
• Appendix A - Parent Acknowledgement - Portuguese Brazil
• Appendix B - Social Security Number Information
• Appendix B - Social Security Number Information - Spanish
• Appendix B - Social Security Number Information - Chinese
• Appendix B - Social Security Number Information - Korean
• Appendix B - Social Security Number Information - Vietnamese
• Appendix B - Social Security Number Information - Portuguese Brazil
• Appendix D - Roster Information Form
• Appendix D - Roster Information Form - Spanish
• Appendix D - Roster Information Form - Chinese
• Appendix D - Roster Information Form - Korean
• Appendix D - Roster Information Form - Vietnamese
• Appendix D - Roster Information Form - Portuguese Brazil
• Child Registration Form
• Child Registration Form - Spanish
• Child Registration Form - Chinese
• Child Registration Form - Korean
• Child Registration Form - Vietnamese
• Child Registration Form - Portuguese Brazil
• Parental Agreement
• Parental Agreement - Spanish
• Parental Agreement - Chinese
• Parental Agreement - Korean
• Parental Agreement - Vietnamese
• Parental Agreement - Portuguese Brazil

Pre-K Program Forms

These forms are intended to be used at the program and site level.

• Appendix E - Suspension Notification Form
• Appendix F - Chronic Absenteeism or Tardiness Report
• Appendix G - Curriculum Selection Form
• Appendix L - Class Closure Notification
• Appendix M - Long-Term Substitute
• Appendix N - Reconciliation
• Appendix O - Request to Move a Pre-K Class
• Appendix P - Checklist for Student Files
• Appendix W - Modified Day Request Form

Pre-K Waiting List Forms

These forms are intended to be used with families who are interested in attending a Georgia’s Pre-K program for the upcoming school year.

• Appendix C - Waiting List Information Form
• Appendix C - Waiting List Information Form - Spanish
• Appendix C - Waiting List Information Form - Chinese
• Appendix C - Waiting List Information Form - Korean
• Appendix C - Waiting List Information Form - Vietnamese
• Appendix C - Waiting List Information Form - Portuguese Brazil

Pre-K and CAPS

DECAL does not require Pre-K providers to offer extended day services; however, providers are required to work with families needing extended day services to ensure the needs of the family are met. Families may receive services through the Childcare and Parent Services (CAPS) program if they meet all eligibility requirements.

• Pre-K CAPS Referral Form
• Pre-K CAPS Referral Form Spanish
• Pre-K CAPS Referral Form Chinese
• Pre-K CAPS Referral Form Korean
• Pre-K CAPS Referral Form Vietnamese
• Pre-K CAPS Referral Form Portuguese Brazil

Emergency Preparedness

These are Emergency Preparedness documents related to Child Care Learning Center programs. Centers may develop their own forms that meet all the requirements of the rules and regulations.

• GA Statewide Child Care Emergency Plan
• Child Care Learning Center Emergency Plans Template
• Emergency First Steps - Response Aid
• Child Care Program Disaster Response Self-Assessment

Child Development Forms

For sample lesson plans and resources related to planning developmentally appropriate activities, go to the Georgia Early Learning and Development Standards (GELDS) website.

• Georgia Early Learning and Development Standards (GELDS)

Center

These sample forms are related to Child Care learning Center programs and are optional. Centers may develop their own forms that meet all the requirements of the rules and regulations.

• Center - 25 Square Foot Request
• Center - Active Supervision Plan Resource
• Center - Best Practices for Playground Surfacing Requirements
• Center - Daily Attendance & Arrival/Departure Record
• Center - Communicable Disease Chart
• Center - Diapering Handout
• Center - Department of Public Health's Georgia Safe Siting Program Fact Sheet
• Center - Department of Public Health's Georgia Safe Siting Program Guidelines
• Center - Preventing TV, Furniture and Appliance Tip-Over
• Center - Emergency Drills Form
• Center - First Aid Guide - Manual
• Center - First Aid Kit Checklist
• Center - Handwashing Chart
• Center - Staff Handwashing Rules
• Center - Children's Handwashing Rules
• Center - Incident Accident Report Form
• Center - Medication Authorization Form
• Center - Playground Maintance Checklist
• Center - Steps for Successful Application
• Center - Weather Watch Chart
• Center - Safe Sleep Practices Policy
• Center - Poison Prevention Manual

Child Care Center Forms

These forms are related to Child Care Centers.

• Facility Update Form
• DECAL KOALA Instructions for Uploading Adminsitrative Review Documents
• Applicant's Guide to Licensing
• Change of Ownership Applicant Guide

Staff

These are Staff related documents.

• Staff - Criminal Record Check Information
• Staff - Professional Learning Plan
• Staff- Employment Application
• Staff - 10 Year Work History Form
• Staff - Employee Documentation Record
• Staff - Initial Staff Training Record
• Staff - Staff Orientation Form

Nutrition

These are Nutrition related documents.

• Nutrition - Connecting Mealtime to GELDS
• Nutrition - Criteria for Sack Lunches
• Nutrition - Reducing the Risk of Choking in Young Children
• Nutrition - Updated Infant Meal Patterns
• Nutrition - Updated Child and Adult Meal Patterns

Child

These are Child related documents.

• Child - Food Allergy & Anaphylaxis Emergency Care Plan
• Child - Food Allergy & Anaphylaxis Emergency Care Plan (Spanish-language version)
• Child - Authorization to Dispense External Preparations
• Child - Enrollment and Emergency Medical Authorization
• Child - Infant Feeding Plan
• Child - No Liability Insurance Parent Acknowledgement
• Child - Parental Agreements with Child Care Facility Form
• Child - Swim Test Form

Transportation

These are Transportation related documents.

• Transportation - Agreement
• Transportation - Record
• Transportation - Vehicle Inspection Form
• Transportation FAQs
• Transportation - Vehicle Emergency Form
• School Transportation Form
• Home Transportation Plan
• Field Trip Transportation Form
• Multi Function School Activity Bus Fact Sheet
• Sample Field Trip Form
• Sample Field Trip Form with phone call
• Sample Home Transportation Form
• Sample Home Transportation Form with phone call
• Sample School Transportation Form
• 12 and 15 Passenger Van Fact Sheet
• School Bus Fact Sheet
• Shuttle Bus Fact Sheet
• Van and Passenger Vehicles Fact Sheet

Posted Notices

These are Posted Notices.

• Posted Notices - Consumer Product Safety Poster
• Posted Notices - Communicable Disease Chart
• Posted Notices - Emergency Numbers
• Posted Notices - Georgia Poisonous Plant List
• Posted Notices - No Liability Insurance
• Posted Notices - No Smoking Sign
• Posted Notices - Parents Rights Poster
• Posted Notices - Required Items List

Child Care Learning Center Forms in Spanish

These forms are related to Child Care Learning Centers in Spanish version.

• Children's Handwashing Chart - Spanish
• Emergency Drills Form - Spanish
• Emergency First Steps Response Aid - Spanish
• Emergency Response Plan - Spanish
• First Aid Kit Checklist - Spanish
• Infant Feeding Plan - Spanish
• No Liability Acknowledgment Form - Spanish
• No Smoking Sign - Spanish
• Posted Notice - No Liability Coverage - Spanish
• Posted Notice - Parents Right Poster - Spanish
• Preventing TV, Furniture and Appliance Tip-Over - Spanish
• Staff Handwashing Rules - Spanish
• Weather Watch Chart - Spanish

Emergency Preparedness

These are Emergency Preparedness documents related to Family Child Care Learning Home programs. Homes may develop their own forms that meet all the requirements of the rules and regulations.

• Family Child Care Learning Home Emergency Plans Template
• GA Statewide Child Care Emergency Plan
• Child Care Program Disaster Response Self-Assessment

Family Child Care Learning Home Forms

These forms are related to Family Child Care Learning Homes.

• Active Supervision Plan Resource
• Authorization to Dispense Medication
• Best Practices for Playground Surfacing Requirements
• Children's Handwashing Rules
• Staff Handwashing Rules
• Department of Public Health's Georgia Safe Siting Program Guidelines
• Department of Public Health's Georgia Safe Siting Program Fact Sheet
• DECAL KOALA Instructions for Uploading Adminsitrative Review Documents
• Communicable Disease Chart
• Connecting Mealtime to GELDS
• Department of Public Health's Georgia Safe Siting Program Fact Sheet
• Emergency Number Form
• Facility Update Form
• Family Child Care Learning Home Applicant Guide
• Family Child Care Pre-Licensing Course
• Family Child Care Learning Home Parent Handbook
• Family Child Care Learning Home Emergency Plans Template
• FCCLH Food Sponsors
• FCCLH Policies and Procedures Guide Sample
• FCCLH Sign in Sheet
• Georgia Poisonous Plant List
• Infant Feeding Plan
• Incident Report Form
• No Liability Acknowledgment Form
• Nutrition - Criteria for Sack Lunches
• Preventing TV, Furniture and Appliance Tip-Over
• Request to Care for Additional Children
• Change of Ownership Online Application Walk-Through
• Reducing the Risk of Choking in Young Children
• Relationship Status and No comp Affidavit
• Poison Prevention Manual

Family Child Care Learning Home

These sample forms are related to Family Child Care Learning Homes that programs may use, if they choose. Family providers may develop their own forms that meet all the requirements of the rules and regulations.

• Emergency Drills Form
• First Aid Kit List
• First Aid Guide - Manual
• Weather Watch Chart

Staff

These are Staff related documents.

• Application for Employment
• Staff Orientation Form
• Staff - 10 Year Work History Form

Posted Notices

These are Posted Notices.

• No Smoking Sign
• Posted Notice - No Liability Coverage
• Posted Notice - Parents Right Poster

Family Child Care Learning Home Forms in Spanish

These forms are related to Family Child Care Learning Homes in Spanish version.

• Authorization to Dispense Medication - Spanish
• Emergency Drills Form - Spanish
• Emergency Numbers Form - Spanish
• FCCLH Applicant Guide - Spanish
• FCCLH Emergency Plans - Spanish
• FCCLH Food Sponsors - Spanish
• FCCLH Parent Handbook - Spanish
• FCCLH Policies and Procedures Guide Sample - Spanish
• FCCLH Sign In Sheet - Spanish
• Infant Feeding Plan - Spanish
• No Liability Acknowledgment Form - Spanish
• No Smoking Sign - Spanish
• Posted Notice - No Liability Coverage - Spanish
• Posted Notice - Parents Right Poster - Spanish
• Preventing TV, Furniture and Appliance Tip-Over - Spanish
• Relationship Status and No Comp Affidavit - Spanish
• Request to Care for Additional Children - Spanish
• Staff Handwashing Rules - Spanish
• Staff Orientation Checklist - Spanish
• Weather Watch Chart - Spanish

Annual Renewal Information

Below are the Annual Renewal Documents

• FY 2024 CACFP Annual Documentation Requirements
• FY 2024 CACFP Revised Forms -Documents- Policies Chart
• FY 2024 CACFP Renewal Application Instructions

CACFP Forms for All Institutions

The forms below must be completed by institutions to change or update their current application or status.

• CACFP Electronic Enrollment/Update Form
• CACFP Mileage Record- Administrative Staff
• CACFP Mileage Record- Operating Staff
• Delegation of Authority Form
• Excess Funds Use Request Form
• SAVE Affidavit with Verification Documents
• Tax Exempt Status Certification for Churches
• Tax IRS Form W-9
• Voluntary Closure Form-CACFP-Termination of CACFP Agreement
• Vendor Management Form Instructions
• Vendor Management Form

Childcare Centers, At-Risk Afterschool or Outside School Hours Program Forms

Below are applications and supporting documentation for sponsoring organizations of centers to complete when adding new sites.

• Add A Site Checklist - (At Risk or Outside School Hours Centers Only)
• Add A Site Checklist - Center Sponsor (Adding traditional Child or Adult Facilities)
• Add A Site Checklist- Administrative Sponsor (Adding traditional Child or Adult Facilities)
• Add A Site Checklist for Independent Centers Adding Sites
• Agreement to Furnish Food
• Agreement to Furnish Meals - FSMC (CACFP)
• Alternate Licensure Form - Child Care Centers Only
• Annual SAVE Affirmation Form
• At Risk Weekly Menu and Food Service Record
• Agreement to Furnish Food Items (SFSP)
• Attachment R – Procurement Checklist
• Budget Checklist
• Budget Guidance Manual
• CACFP Child Care Standards
• CACFP Field Trip & Closure Notification Form
• Child Care Center Monitoring Form
• Child Care Center Monitoring Form Instructions
• CACFP Center/Site Application
• Child Care Weekly Menu and Food Service Record
• Donated Food Documentation Form
• Equipment and Depreciation Record
• Food Service Permit Inquiry Form
• Farm to ECE Harvested Food Form
• Federal Closeout - Total Inventory Record Form
• Federal Closeout - Transfer Record Form
• FY 2024 Application Update Procedures
• Household Contact Form
• Household Contact Form Instructions
• IES Household and Verification Letters
• Immigration Affidavit and Agreement
• Income Eligibility Form – Effective Date Option
• Income Eligibility Package - Spanish
• Income Eligibility Statement
• Infant Weekly Menu and Food Service Record
• Institution Change Notification
• Invitation for Bid and Contract for Vendors
• Invitation for Bid and Contract FSMC
• Loss or Destruction of Records Form
• Media Release for All Non-pricing Programs
• Milk Calculation Chart - Eff 10/1/2017
• Monthly Attendance Record Form (Optional) (Excel version)
• Monthly Record of Cost Form (Excel version)
• Monthly Record of Cost Form (Word version)
• Offer Versus Serve Option for School Food Authorities (SFA) Form
• Preoperational Visit Form & Instructions
• Procurement Advertisement Checklist
• Procurement and Purchasing Policy Template
• Procurement Contract Checklist
• Procurement Review Workbook (sample)
• Projected Reimbursement Worksheet
• Racial and Ethnic Data Collection Combined Form Institutions and Sponsors
• Racial and Ethnic Data Individual Collection Form
• Records Check Application for DECAL (PDF)
• Reduced Price Income Guidelines
• Related Party Disclosure Form
• Roster for Child Care Center
• Sample Infant Affidavit
• Sample Media Release - Pricing Child Centers
• Sample-Sponsor and Unaffiliated Center Agreement
• School-Age Children Certification Statements for the CACFP during COVID-19 (Independent Centers)
• School-Age Children Certification Statements for the CACFP during COVID-19 (Sponsoring Organizations)
• Site Change Notification Form
• Small Purchase Item Documentation Form
• Specific Written Prior Approval Form
• Sponsor Serving as FSMC Form
• Sponsor Update Form
• Sponsoring Organization Minimum Review Worksheet
• Staff Distribution Worksheet
• Tax Exempt Status Certification for Churches
• Termination Letter for Admin Sponsor
• Time Distribution Report
• Time and Attendance Distribution Report (FY 2022)
• Waiver of Budget and Management Plan (School Food Authorities only)
• WIC Fact Sheet & Income Guide

DCH Sponsor Forms

Below are required documents for sponsoring organizations of day care homes.

• CACFP Advance Application
• Child Enrollment Form - DCH Providers
• DCH Projected Reimbursement Worksheet
• DCH Weekly Meal Count Record
• DCH Weekly Menu Record
• Enrolled Homes & Update Form Part I
• Enrolled Homes & Update Summary Form Part2
• Enrolled Homes and Update Summary Form
• Enrollment Roster
• Family Child Care Learning Home Monitoring Form
• Family Child Care Learning Home Monitoring Form Instructions
• Household Contact Form
• Income Eligibility Stmt Provider's Own Children
• Loss or Destruction of Records Form
• Media Release for All Non-pricing Programs
• Pre-Op Form for Day Care Home Providers
• Pre-Op form for Informal Providers
• Provider File Checklist
• Sample-Sponsor and Provider Agreement
• Sponsoring Organization Minimum Review Worksheet
• Tiering for DCH Provider Reimbursement
• Verification Information

Adult Day Care Homes Forms

Required documents for Adult Day Care Homes

• Add A Site Checklist - Center Sponsor (Adding traditional Child or Adult Facilities)
• Add A Site Checklist- Administrative Sponsor (Adding traditional Child or Adult Facilities)
• Adult Day Care Center Monitoring Form
• Adult Day Care Center Monitoring Form Instructions
• Adult Daycare Center Application
• Adult Weekly Menu and Food Service Record
• IES Household and Verification Letters
• Roster for Adult Day Care Center
• Sample Media Release - Pricing Adult Centers
• Sponsoring Organization Minimum Review Worksheet

SFSP Application Forms

Below are forms to be used by sponsoring organizations during the application process

• Affidavit Verifying Applicant Status for Public Benefits (SAVE Affidavit)
• Annual Affirmation Statement- SAVE Requirements
• Application Instruction Booklet - Happy Helpings
• Application Update Procedures - Happy Helpings
• ATLAS Enrollment/Change Form, Att. N1
• Delegation of Authority Form
• Demonstration Project Request Form for Non-Congregate Feeding
• Food Service Permit Inquiry Form
• FY 2023 Happy Helpings Revised Forms-Documents-Policies Chart
• Happy Helpings Site Update Form, Att. Q
• Health Department Form Letter Att E
• Home Delivery Certification Statement
• Household Letter
• Immigration Affidavit and Agreement
• Menu Form - SFSP
• Menus for Nutrition Guidance, Att. F
• Offer Versus Serve Option for School Food Authorities (SFA) Form - December 19, 2014
• Public Release Certification Enolled/Camp, Att. C2
• Public Release Certification Migrant and Open Site, Att. C1
• Public Release Certification Site Listing, Att. C3
• Sample Media Release, Att. 12
• Sample School Food Auth Letter, Att. I
• Sponsor Application Checklist- Happy Helpings, Att. A-1
• Tax Exempt Status Certification for Churches
• Tax IRS Form W-9
• Vendor Management Form Instructions
• Vendor Management Form-Attachment N

SFSP Financial Forms

Below are forms to be used by sponsoring organizations to request and document the use of SFSP reimbursement

• ADP Calculation - SFSP
• Allocation Tool
• Annual Year End Reconciliation Form
• Annual Year-End Reconciliation Form Instructions
• Budget Disaster Relief Template
• Equipment Depreciation & Inventory
• Excess Funds Use Request Form
• Farm to ECE Harvested/Sold Food Form (SFSP)
• Financial Allocation Methods
• Methods of Depreciation & Acquisition Cost
• Potential Reimbursement Worksheet, Att. 27
• Pre-Award Costs Request Form
• Related Party Disclosure Form
• Specific Written Prior Approval Form
• Staff Distribution Worksheet
• Total Projected Income Worksheet

SFSP Program/Administrative Forms

Below are program and administrative forms to be used by sponsoring organizations during the operation of the SFSP

• Daily Meal Count Form - SFSP, Att. 18
• Daily Meal Count Form (Mobile Feeding Only), Att. 18A
• Delivery/Pick Up Receipt - SFSP, Att. 17
• Field Trip & Closure Notification Form, Att. O
• Income Eligibility Form - Attachment 10
• Income Eligibility Form – Effective Date Option
• Loss or Destruction of Records Form
• Meal Count Worksheet for Residental or Day Camps with Sponsor Consolidation Form, Att. 16
• Mileage Record: Admin Staff, Att. 23
• Mileage Record: Site and Food Service Staff, Att. 24
• Monthly Record of Cost Form - Word
• Monthly Record of Cost Form - Excel
• Racial and Ethnic Data Individual Collection Form
• Racial and Ethnic Data Collection Combined Form Institutions and Sponsors
• RecordKeeping Guide - SFSP
• Site Supervisor Meal Count (Weekly Consolidation), Att. 19
• Sponsor Site Agreement - SFSP, Att. 14
• Sponsor's Monthly Consolidation Form of First and Second Meals Served, Att. 20
• Time Report: Admin Staff - SFSP, Att. 25
• Time Report: Food Service Staff - SFSP, Att. 26
• Time Distribution Report: Dual Admin Oper Staff – SFSP, Att. 27

SFSP Training Forms

Below are the forms to be used by sponsoring organizations to document training conducted for sponsor and site staff

• Food Service/Site Staff Sign-in Sheet, Att. M2
• Monitor Sign-in-Sheet, Att. M3
• New Site Supervisor, Att. M1

SFSP Monitoring Forms

Below are the forms to be used by sponsoring organizations to conduct required monitoring of SFSP sites.

• Optional Combined Site Visit and Review Form Att. L4
• Pre-Operational Visit Form, Att. L1
• Site Visit Form, Att. L2
• Site Review Form, Att. L3

Procurement Forms

Below are forms to be used by sponsoring organizations during the operation of the SFSP

For additional Procurement resources and information, click here

• Agreement to Furnish Food Items (SFSP)
• FSMC Agreement to Furnish Meals (SFSP)
• FSMC Contracted Labor Agreement to Furnish Meals (SFSP)-Pay per Meal
• FSMC Contracted Labor Agreement to Furnish Meals (SFSP)-Pay per Staff
• Invitation for Bid and Contract FSMC
• Invitation for Bid and Contract for Vendors
• Procurement And Purchasing Policy Template
• Procurement Manual
• Small Purchase Item Documentation Form
• Sponsor Serving as FSMC Form
• Suspension and Debarment Certification Form
• Vendor Registration Form