CITY OF OAK PARK, MICHIGAN
DAY CARE REGISTRATION
The Municipal Code of Ordinances of the City of Oak Park requires that all Child Day Care Homes register with the City and that all
license applications and fees are due by December 31.
PLEASE FILL THIS FORM OUT COMPLETELY AND RETURN WITH $25.00 FEE MADE PAYABLE
TO THE CITY OF OAK PARK ALONG WITH A COPY OF YOUR CERTIFICATION FROM THE STATE
OF MICHIGAN, DEPARTMENT OF HUMAN SERVICES, BUREAU OF CHILDREN AND ADULT
LICENSING
APPLICANT (LICENSEE) INFORMATION: New Renewal
Applicant(s) Name:
Home Address:
Phone Number: Email Address:
PROPERTY OWNER INFORMATION:
Owner(s) of the Property:
Address of Owner(s):
Phone Number: Email Address:
CONTACT PERSON:
Name: Phone Number:
Address:
CERTIFICATION INFORMATION (ATTACH A COPY OF CERTIFICATION):
I certify that I am currently licensed by the State of Michigan, Department of Human Services to provide
child care.
Certification #: Capacity (# of children):
Certification Effective Date: Certification Expiration Date:
Applicant Signature: Date:
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INTERNAL OFFICE USE ONLY
FEE PAID: YES NO LICENSE # DATE ISSUED:
CITY CLERK’S OFFICE APPROVAL:
YES NO
CITY CLERK’S OFFICE SIGNOFF:
click to sign
signature
click to edit
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