Program Forms & Documents

The following items are resources for each of our programs and services. For parents and child care providers who participate in our programs, please consult with a Program Specialist about which forms are required of you. If you would like to have a document or form mailed to you, or if you have any questions about these items, please contact your local CHS office.

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For Families

Click Here for Program Forms and Documents for Families

Informational Letter to Active Families and Providers – English

Carta informativa para familias activas y proveedores – Spanish

Child Care Eligibility List (CCEL)

Eligibility Questionnaire – EnglishSpanishVietnamese

Child Care Payment Program (CCPP) and Family Child Care Home Education Network (FCCHEN) – For Families

Family Participation Handbook – EnglishSpanish
Family Participation Handbook – Acknowledgement of Receipt – EnglishSpanish
Child or Spousal Support Affidavit – EnglishSpanish
Declaration Form – EnglishSpanish
Declaration (Employment) Form – EnglishSpanish
Declaration – Reduction – English – Spanish
Declaration Form (In-Home Provider) – EnglishSpanish
Domestic Services Employment Verification – EnglishSpanish
Educational Program Verification – EnglishSpanish
Employment/Income Verification – EnglishSpanish
Participation Requirements – At Risk – EnglishSpanish
Participation Requirements – Child Protective Services – EnglishSpanish 
Participation Requirements – Educational Program – EnglishSpanish
Participation Requirements – Employment – EnglishSpanish
Participation Requirements – Homelessness – EnglishSpanish
Participation Requirements – Parental Incapacity – EnglishSpanish
Participation Requirements – Seeking Employment – EnglishSpanish
Participation Requirements – Seeking Permanent Housing – EnglishSpanish
Participation Requirements – Vocational Training – EnglishSpanish
Record of Income – EnglishSpanish
Release and Hold Harmless Agreement – EnglishSpanish
Statement of Homelessness Need – EnglishSpanish
Statement of Parental Incapacity – EnglishSpanish
Statement of Seeking Employment – English Spanish
Statement of Seeking Permanent Housing – EnglishSpanish
Training Verification – EnglishSpanish
Verification of Self Employment/Independent Contractor – EnglishSpanish

Child Care Resource and Referral Program (R&R)

Child Care Referral Policy – EnglishSpanish
CHS Resource & Referral Program Brochure – EnglishSpanish
Choosing Child Care Brochure – EnglishSpanish
Complaint Policy – EnglishSpanish
Parental Choice Brochure – EnglishSpanish

Family Education Program (FEP)

Family Education Program Resource Page
Family Education Program Material Request Website
Family Education Program Material Request Form – English

CareConnect Family

Children’s Home Society of California (CHS) is pleased to offer CareConnect Family to families participating in the Child Care Payment Program (CCPP). CareConnect is an internet site and mobile app that allows families to access, complete, and submit documents directly on their computer or mobile app.

To request an account for CareConnect Family, contact your assigned Program Specialist. If you already have an account for CareConnect Family, click here to log in.

For Child Care Providers

Click Here for Program Forms and Documents for Child Care Providers

Child Care Payment Program (CCPP) and Family child care home education network – For Providers

CCPP Written Information to Providers – EnglishSpanish
CCPP Written Information to Providers – Acknowledgment of Receipt – EnglishSpanish

Informational Letter to Active Families and Providers – English
Carta informativa para familias activas y proveedores – Spanish

Child Care Resource and Referral Program (R&R)

Appeal Policy – EnglishSpanish
Complaint Policy – EnglishSpanish
Child Care Referral Policy – EnglishSpanish
Choosing Child Care Brochure – EnglishSpanish
Resource & Referral Provider Update Form – (English/Spanish/Vietnamese)
Resource & Referral Brochure – EnglishSpanish
Health and Safety Reimbursement Application – Bilingual

Family Education Program (FEP)

Family Education Program Resource Page
Family Education Program Material Request Website
Family Education Program Material Request Form – English

Helpful Forms

Address Declaration – English – Spanish
Attendance Sheet – English/Spanish
Attendance Sheet – FCCHEN Program – English/Spanish
Declaration of Exemption from TrustLine Registration and Health & Safety Self-Certification – English
Direct Deposit Form – EnglishSpanish
Health & Safety Self-Certification CCP4 Form – English
Lost-Stolen Check Affidavit – English – Spanish
Release and Hold Harmless – EnglishSpanish
Trustline Application – EnglishSpanish
W-9 Request for Taxpayer Identification – English Spanish

CareConnect Provider

Children’s Home Society of California (CHS) is pleased to offer CareConnect for child care providers who are participating in the Child Care Payment Program (CCPP). CareConnect is a website and mobile app that allows providers to view authorized care for their enrolled children; access, complete, and submit digital CHS Attendance Sheets to CHS electronically; download and print CHS Attendance Sheets for their enrolled children; check the status of attendance records submitted for payment; and view payment details.

You can access CareConnect in one of the following ways:

  1. Download the CareConnect Application on your iOS or Android device
  2. Go to the CareConnect website https://careconnect.carecloud.io/

For assistance with accessing your account, please contact the Provider Relations Department at your local CHS office.