Dcf f dwsw13259-E POD Regulatory Agency Approval - Acknowledgement to Operate Child Care Business .doc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, where you will provide your personal information including your name, address, email, and telephone number. Ensure all details are accurate for effective communication.
3. Next, check all applicable licenses or certificates you currently hold. This includes options like Adult Day Care or Licensed Family Child Care. If you have other certifications, specify them in the provided space.
4. Fill in the Child Care Certification Agency Information by providing the agency's name, certification worker's name, mailing address, email (if known), and telephone number.
5. Proceed to Section B for the Regulating Agency. Here, the agency representative will answer questions regarding the applicant’s qualifications and any concerns about child care restrictions.
6. Finally, ensure that the regulating agency representative signs and dates the form before returning it to the appropriate Child Care Certification Agency.

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