Instructions
Child Enrollment Form
(HCJFS 4117)

1.    Print a form for each new child in your
       care.

2.    Complete a form for each child. The form
       must be completed on or before the first
       day of care.

3.    Keep completed forms in your files.  Your
       Home Provider Specialist will ask to see
       them during home visits. 

Click here for form