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Mississippi child care paperwork.

MSDH's licensing route covers facilities caring for six or more unrelated children under 13. Small-home operators should confirm whether their program falls under licensure before using facility forms.

Agency: Mississippi State Department of Health (MSDH), Child Care Facilities Licensure
Paperwork source review: September 14, 2026

Use your print window to print on paper or save as a PDF. The organizer is a planning aid for your files.

Check the form and your provider type.

An official agency form is issued or listed by the agency; that label alone does not establish mandatory use. A required state form is identified as mandatory in the cited instructions. A required record identifies information you must maintain; its format may be flexible. An optional template is a suggested format. Official instructions / portal links explain the application or record process.

Read “Applies to” and “Format and applicability” for each item. Home, group-home, center, local licensing, food-program, and subsidy requirements can differ.

Application & renewal

01
Official instructions / portal

New Child Care Facility License Application — Start Here

Start facility licensure and obtain the inspector's document checklist.

Applies to
Programs meeting Mississippi's facility licensing threshold
Who completes it
Applicant/operator
Where it goes
Online MSDH application linked from the guidance page.
When to use or update
Before operation; consult a licensing inspector before committing to a building.

Format and applicability: Public guidance; online application is separate.

Open official source: New Child Care Facility License Application: Start Here ↗https://msdh.ms.gov/page/30,19112,183,776.html
02
Official instructions / portal

Child Care License Renewal — Start Here

Renew the license and supply required inspection approvals.

Applies to
Existing licensed child care facilities
Who completes it
License holder
Where it goes
MSDH online renewal system using the provided PIN.
When to use or update
Annually, before expiration; follow MSDH renewal instructions.

Format and applicability: Public instructions. Fee wording is internally inconsistent; confirm charges with MSDH.

Open official source: Child Care License Renewal: Start Here ↗https://msdh.ms.gov/page/30,19109,183,776.html

Children’s files

05
Official agency form

Immunization Compliance / Exemption Certificates

Form 121 / 122

Document immunization compliance or an approved exemption.

Applies to
Children entering Mississippi daycare
Who completes it
Medical provider/health department issues certificate; parent supplies it
Where it goes
Give the certificate to the child's daycare.
When to use or update
For entry and subsequent immunization-status updates; check current child care guidance.

Format and applicability: Obtain an issued certificate; this is not a blank parent-created immunization form.

Open official source: Form 121 (Immunization Compliance) and Exemptions ↗https://msdh.ms.gov/page/14,25485,71,303.html
07
Optional template

Childcare Enrollment Application — training packet

Collect contacts, custody, allergies, permissions and parent acknowledgements.

Applies to
Licensed child care facilities
Who completes it
Parent/guardian and director
Where it goes
Child's facility record.
When to use or update
Before care; packet provides an annual parent signature/update section.

Format and applicability: Sample within a 46-page official packet; exact sample layout is not established as mandatory.

Open official source: Child Care Training Packet: Regulatory Forms and Checklists, pages 32–33 ↗https://msdh.ms.gov/page/resources/20485.pdf

Safety & daily records

03
Required record

Child Care Facility Fire & Severe Weather Drills Monthly Report

Form 1183

Record required drills, attendance, evacuation time and problems.

Applies to
Licensed child care facilities
Who completes it
Provider/person conducting drill
Where it goes
Available for licensing inspection; instructions identify an electronic licensing file and permanent retention.
When to use or update
Document monthly fire and severe weather drills.

Format and applicability: Official two-page PDF with instructions.

Open official source: Fire & Severe Weather Drills Monthly Report ↗https://msdh.ms.gov/page/resources/8468.pdf
04
Official agency form

Fire Safety Inspection

Form 333

Document fire safety inspection approval.

Applies to
New and renewing licensed child care facilities
Who completes it
Fire marshal/authorized fire inspector
Where it goes
Supply inspection certificate as the licensing official directs.
When to use or update
For prelicensing and renewal inspection documentation.

Format and applicability: Scanned one-page PDF; individual fields were not text-extractable.

Open official source: Fire Safety Inspection (Form 333) ↗https://msdh.ms.gov/page/resources/7675.pdf

Provider & staff files

06
Official instructions / portal

Comprehensive Background Checks — Child Care instructions

Coordinate fingerprint screening and child abuse/neglect registry checks.

Applies to
Applicants and operators of licensed child care facilities
Who completes it
Facility initiates; applicant completes fingerprint and registry steps
Where it goes
MSDH facility/background systems and the linked registry form.
When to use or update
During hiring/background screening; extra affidavit if the applicant lived outside Mississippi within five years.

Format and applicability: Public process guide links secure portals; no login attempted.

Open official source: Comprehensive Background Checks ↗https://msdh.ms.gov/page/30,0,206.html
08
Required record

Child Care Staff Contact Hours Record — training packet

Summarize completed training and attach supporting certificates.

Applies to
Each employee on a licensed facility's roster
Who completes it
Staff/provider
Where it goes
Employee training file.
When to use or update
Record training as completed, organized by the training year.

Format and applicability: Official packet record; confirm current training requirements separately.

Open official source: Child Care Training Packet: Regulatory Forms and Checklists, page 27 ↗https://msdh.ms.gov/page/resources/20485.pdf

What this review covers

Selected official forms and public instructions were reviewed on September 14, 2026. This is a practical starting list, not a complete certification of every record, retention period, local rule, or individual application.

  • Application/renewal fees should be checked directly: the renewal page refers both to required fees and no renewal application fee.
  • The training packet is revised August 2023 and includes older sample dates; current statutes, rules and inspector instructions control.
  • No separate statewide small-home registration or CACFP application was verified in this selection.

Use the agency’s current original and revision instructions. Keep confidential child and staff records in your own secure record system.

Report a changed form or link →

Provider Path · Reusable planning companion

Mississippi paperwork organizer

Use this sheet to check which items apply to your program. A listed item or a checked box does not establish that your program meets licensing requirements.

Program / provider type:

Licensing office / reviewer:

Date checked / rule or packet edition:

Form or instructionApplies?
Yes / No / Ask
Received / completedLocation / next review
1. New Child Care Facility License Application — Start Here
2. Child Care License Renewal — Start Here
3. Child Care Facility Fire & Severe Weather Drills Monthly Report (1183)
4. Fire Safety Inspection (333)
5. Immunization Compliance / Exemption Certificates (121 / 122)
6. Comprehensive Background Checks — Child Care instructions
7. Childcare Enrollment Application — training packet
8. Child Care Staff Contact Hours Record — training packet
Other local or agency document
Food-program / subsidy documents

Questions and next steps

Ask about required format, signatures, submission, update triggers, and retention. Record the agency’s answer and the person or written source that confirmed it.

Companion to the Mississippi source review dated September 14, 2026. Provider Path educational planning sheet.