Child Performer Health Form - Department of Labor: Fill out & sign online

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Click ‘Get Form’ to open the Child Performer Health Form in the editor.
Begin by entering your current address in the designated field. If the preprinted information is outdated, check the box provided.
Attach a check or money order made payable to the Commissioner of Labor as indicated in section A.
For initial applications or changes, upload a copy of your certification (e.g., Certificate of Doing Business) as specified in section B.
Provide photographic proof of identity for each owner or officer, ensuring clarity and legibility as outlined in section C.
Complete sections regarding Workers’ Compensation and Disability Insurance coverage, attaching necessary certificates as per section D.
Fill out all required fields on every page, including business details and ownership structure. Ensure you sign and date the application before submission.

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