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Child Enrollment Form for Day Care Homes (DOH-4419)-2025

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4.1 out of 5

54 votes

The document is a Child Enrollment Form for the New York State Department of Health's Child and Adult Care Food Program, designed for day care homes. It requires parents or guardians to provide information about their child(ren), including personal details, ethnic and racial information, care schedules, meal preferences, and contact information. The form also includes sections for infant feeding statements and emergency placement details, ensuring compliance with program requirements.

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Click ‘Get Form’ to open the Child Enrollment Form in the editor.
Begin by entering the Provider number and the name of the Day Care or Owner/Operator at the top of the form.
Fill in the child's name, child number, and date of birth. Ensure you select the gender for each child.
Provide ethnic and racial information for each child by selecting the appropriate options from the checkboxes.
Indicate the primary language spoken at home and check any applicable boxes regarding special circumstances related to care.
Complete the hours, days, and meals section by specifying when care begins and ends, as well as meal preferences.
If applicable, complete the Infant Feeding Statement for children under one year old.
Finally, fill out contact information for both parents/guardians and ensure signatures are provided along with dates.

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See more Child Enrollment Form for Day Care Homes (DOH-4419) versions

We've got more versions of the Child Enrollment Form for Day Care Homes (DOH-4419) form. Select the right Child Enrollment Form for Day Care Homes (DOH-4419) version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2024	4.5 Satisfied (29 Votes)
2019	4.1 Satisfied (54 Votes)
2012	4.7 Satisfied (37 Votes)

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