This form is to be used for the review of Family home day cares designed to accommodate more than five, but not more than twelve persons, excluding staff, but including children under the age of twelve related to staff or adult caregiver which operates between the hours of 6:00 AM and 10 PM.

CAREGIVER MUST RESIDE IN THE HOME

Homes operating after 10:00 PM or before 6:00 AM, must meet additional, specific requirements