Children and Families (Wales) Measure 2010
Application to register as a child minder

Mae’r ffurflen gais hon hefyd ar gael yn Gymraeg / This application form is also available in Welsh

It is essential in preparing your application that you are familiar with the legislation below.

You need to be aware that from 1 April 2016 the Children and Families (Wales) Measure 2010, the Child Minding and Child Minding and Day Care Regulations and the National Minimum Standards for Regulated Child Care were amended. You can find out how these changes may affect you by looking on our website www.careinspectorate.wales

•	Part 2 of the Children and Families (Wales) Measure 2010
•	The Child Minding and Day Care (Wales) Regulations 2010
•	The Child Minding and Day Care (Wales) (Amendment) Regulations 2016
•	The Child Minding and Day Care (Disqualification) (Wales) Regulations 2010
•	National Minimum Standards for Regulated Child Care

To assist you in completing your application, please refer to the Information and Guidance page on our website https://careinspectorate.wales/register-become-child-minder. 

The application form is divided into two distinct parts. Both parts must be completed in full.

Important:
You are required to present a current DBS certificate (ie.no older than three months since date of issue) to support your application. This must be the original certificate and not a copy.

Where possible you should obtain one via your employer or umbrella body. Where this is not possible you may contact Care Inspectorate Wales on 0300 7900 126 and an advisor will give you details about how to do this. 

Guidance for Applicants is available and this will provide you with step-by-step guidance on completing your form.

A checklist of additional documents that must be submitted with the application is included at the end of the application form.  

About you, the care you want to provide, your premises and people who work/live with you

Part 1		

Section 1 - Information about you (the applicant)
Details requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 1, Part 1 as amended by The Child Minding and Day Care (Wales) (Amendment) Regulations 2016. 

Title:	     	  Surname:	     

First names:	     	Date of birth:
(dd/mm/yyyy)	     	

Any aliases and former names:	     	

Home address:	     

Post Code:		

Address where child minding is to take place, if different from your home address: 	     	

Email address:	     	

Telephone number:	     	

Mobile number:	     	

Date of establishment of the service or proposed date:	           (dd/mm/yyyy)	

Language provision of proposed service:                                                          
(please tick one box only	
Welsh      English      Bilingual 
	
Preferred language of inspection: 
Please note that Welsh medium services will normally be assigned a Welsh speaking inspector to carry out your inspection so that they will be able to speak with people who use your service. 

For English medium and bilingual services only:
Welsh
   	
English

If your application is successful and you intend to provide an English medium or bilingual service, in which language would you like your inspection to be carried out?  
(please tick one box only)	

Preferred language of communication 
for telephone calls: 
(please tick one box only)	
Welsh
   	
English

	

Preferred language of written communication: 
(including emails and letters) 
(please tick one box only)	
Welsh
   	
English
   	
Both

	

If your application is accepted a fit person's interview will take place as part of the registration process. In which language would you like your interview to be conducted? 
 (please tick one box only)	Welsh
	
English

	

Qualifications and experience

Please provide details of your professional/technical qualifications that are relevant to looking after children under the age of 12 years:
     

	

Please tell us here about any experience relevant to looking after children under the age 12 years that will support your application to be a registered child minder
     

	

Please provide details below of any business you are carrying on at present or that you have carried on in the past	
Details of business	Dates you carried on this business	
     	     	
     	     	
     	     	
     	     	
     	     	
		
Your work history		
Please provide details of your work history covering the period between leaving school and now, including the year and month of each change of occupation. Remember to include periods of study and volunteering.

Where there are gaps in employment please explain, giving enough detail of the circumstances, to enable checks to be made if necessary. Please be sure to include any experience you consider to be relevant to the present application including any previous
work with children, whether paid or not.

If any of your previous duties involved working with children, give the full reasons why your employment or position ended with the details of how this can be confirmed

Occupation	
From month and year
(mm/yyyy)	
To month and year
(mm/yyyy)	Reason for leaving, including any disciplinary action	Name, address and telephone number of person/company we may contact to confirm	
     
	     	     	     	     	
     
	     	     	     	     	
     
	     	     	     	     	
     
	     	     	     	     	
     
	     	     	     	     	
     
	     	     	     	     	

Please explain any gaps in your employment record above (include dates)
     	

References
Please supply the names and addresses of two individuals from whom we will take up references.  The people you name must not be related to you. Both of these referees must be able to comment on your competence to look after children under the age of 12 years. Where possible, one of the referees should be your current or most recent employer (‘Current employer’ means who you are employed by at the time you submit this application).  You should give the name of your current or most recent employer as the first.

Reference 1
Name:	     
	
Address: (including post code)	     	
Telephone number:	     

Occupation:	     	

In what capacity are you known to them?
e.g. employee, friend, colleague and how long have they known you.	     

	
Reference 2
Name:	     
	
Address including post code:	     	
Telephone number:	     

Occupation:	     

In what capacity are you known to them?
e.g. employee, friend, colleague and how long have they known you.	     

	

Medical practitioner report
Important: You are required to provide a report by a registered medical practitioner as to your physical and mental fitness to look after children under the age of 12 years.

This must be submitted as part of your application.  A template for this reference is attached (see Appendix 1).

If you are unable to obtain this report please explain why and provide a statement on a separate sheet as to the state of your physical and mental health.

Disclosure and Barring Service (DBS) check

You are required to present a current DBS certificate (ie.no older than three months since 
date of issue) to support your application. This must be the original certificate and not a copy.

Where possible you should obtain one via your employer or umbrella body. Where this is not possible you may contact Care Inspectorate Wales on 0300 7900 126 and an advisor will give you details about how to do this. 

Guidance for Applicants is available and this will provide you with step-by-step guidance on completing your form on our website www.careinspectorate.wales   

Important: From April 1 2018 all applicants will be required to meet the cost of their DBS application.

Additional Personal Information

The following information is requested under the Children and Families (Wales) Measure 2010 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.

Please note: You are disqualified from registration as a child minder if you or any person living or working in your household is disqualified under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.  CIW will carry out various checks including local authority social services departments and its own records. 

A person is able to apply for a waiver from disqualification in certain circumstances.  

Have you ever:

•	Been refused registration in respect of a children’s home or 
	voluntary home?							    Yes  	No 

•	Had your registration in respect of a children’s home or
	voluntary home cancelled? 					    Yes	 	No 

•	Been concerned in the management of, or had any 
	financial interest in a children’s home or voluntary home 
	in respect of which another person has had their 
	registration cancelled? 						    Yes  	 No 

If you answered yes to any of the above please provide details including details of the registration authority, name and address of the home, nature of your connection with the home, type of action taken against you and the date
     

	

Have you ever:
•	Been refused registration in respect of the provision		Yes		No    
of nurseries, day care, child minding or other provision 
of day care?

•	Been disqualified from registration in respect			Yes		No    
of the provision of nurseries, day care, child minding 
or other provision of day care?

•	Had registration cancelled in respect of the provision	Yes		No    
of nurseries, day care, child minding or other provision 
of day care?

If you answered yes to any of the above please provide details including details of the registration authority, name and address of the provision, nature of your connection with the provision, type of action taken against you and the date
     

	

Do you know of any other reason why you may be disqualified from registration as a child minder under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010? A copy can be found on our website www.careinspectorate.wales

Yes		No	     
                                                                      
If you answered yes, please provide details here
     

	

Please be aware that a failure to disclose a matter which would disqualify you from registration as a child minder may affect your ability to be granted a waiver.

Social services check
Please complete the attached consent form which authorises CIW to contact social services departments for information (see Appendix 2).  (This also applies to all persons aged 16 years and over who live or work in your household).

Section 2 - Information about the care provided
Details requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 2. 
Information on premises
Please provide the details requested below about the premises you intend to use to look after children.

Name and address of premises: (including postcode)	     	

Email address:	     	
Telephone number:	     	
Fax number: (if applicable)	     	
 
Please describe the area in which the premises are located and details of access to the premises
     	

Please attach a plan of the premises with this application showing the dimensions of each room in metres and centimetres.  It will help if it is drawn to scale, but should show accurately the sizes and positions of windows, internal doors, stairs and external exits. Please note: You do not need to commission a professional set of plans for this purpose, but the plan you submit needs to be as accurate as possible.

Important: Planning permission and building control

You are advised to seek advice on planning permission from your local authority planning department. You should check with your local planning department to find out whether or not you need planning permission to run a business as a child minder from your home. You must also ensure that the local authority building control department is satisfied with the standard of any building work undertaken. 

Do you:

-  Own the premises?	Yes		No	

-  Lease the premises?	Yes		No	

-  Rent the premises?	Yes		No	

If leasing or renting, how much notice to vacate would have to be given?
     

If you rent or lease the premises, please provide a letter of confirmation from your landlord that they agree to your child minding from these premises.

Please provide a statement regarding the security arrangements at the premises including arrangements for the purpose of:

a)	Safeguarding access to information held at the premises
     

	

b) Restricting access from adjacent premises, or when the premises form part of a building, from other parts of the building
     

	

Will any business or activity be carried on in the premises at 
the same time as children are looked after there?			        Yes 	No    

If yes, please give details
     

	

Will you be providing child care via a funded programme (eg. ‘Flying Start’, ‘Foundation   Phase’)?                                                                                             Yes           No  

If ‘Yes’ please provide details below:
     
	
Is another child minder already operating from the premises?                 Yes      No 

If yes, please give details including the name of any other child minder(s)
     

	

Do you have any pets? 							             Yes     No 

If yes, please give details
     

	

Hours of Operation
Please indicate below what hours you intend to operate as a registered child minder
	
AM	
PM	

Monday	     	     	

Tuesday	     	     	

Wednesday	     	     	

Thursday	     	     	

Friday	     	     	

Saturday	     	     	

Sunday	     	     	

Do you intend caring for a minded child overnight? 			Yes		No	
Section 3 - Information about other persons
Details requested in this section are required under the Child Minding and Day Care (Wales) Regulations 2010 Schedule 2, Part 1. 
You will need to provide information about your own children and any others for whom you are responsible, any other person who is going to mind children with you, and anyone else (over the age of 16 years) who is likely to have contact with the minded children and/or lives or works on the same premises where the child minding service is to be provided.

3A Information about your own children and any others for whom you are responsible

The maximum number of children for whom a child minder may care is as follows (this includes your own children and any other children you may be caring for and not receiving a reward e.g. grandchildren, foster children):

•	Ten children under the age of  twelve years 
•	Of those ten children, no more than six may be under eight years of age
•	Of those six children, no more than  three may be under five years of age
•	Of those three children, normally no more than two may be under 18 months of age, although exceptions can be made for siblings

The space available for children on the premises may also affect the numbers for which provision can be registered.

Please provide details below about your own children and any others under the age of 16 years for whom you are responsible, (including any children who are in full time education and those you will be looking after at the same time as you are child minding)

Full Name	
Date of Birth

(dd/mm/yyyy)	
Relationship to you	Tick here if this child will be present  while you care for minded children	
     	     	     	
	
     	     	     	
	
     	     	     	
	
     	     	     	
	
     	     	     	
	
     	     	     	
	
     	     	     	

Please provide the number and ages of children you propose to look after if you are registered as a child minder:
Number of children in total 	     	

0	-  under 18 months: 	     	

18 months - under 5 years       	     	

5 – under 8 years                             	     	

8 years – to under 12 years	     	
 
3B Information about any assistants you intend to employ

Do you plan to have someone assist you with your child minding?    Yes   	 No  

If no, please go to Section 3C.

If yes, please provide the details requested in the table below.

If you intend employing more than one assistant you must provide all of the details below for each assistant.
Full name of assistant
	     	

Any alias and former names
	     	

Date of birth
(dd/mm/yyyy)	     	

Please give details of the person’s duties and responsibilities in relation to their work with you
     

Will the person be resident on the premises? 	Yes		No   

Is the person a relative of yours? 			 Yes		No   

If yes, please state what the relationship is	     	

Number of hours person will work per week	     	

Date on which the person commenced work/is intended to commence work with you	     	

Details of the person’s qualifications to look after children under the age of 12 years
     

	

Details of the person’s skills and experience to look after children under the age of 12 years
     	

I confirm that I am satisfied with the authenticity
of the above person’s qualifications 				Yes		No	

I confirm that I have verified the experience
and skills of the above person 					Yes		No	

I am satisfied that the person’s qualifications
are suitable for the work they are to perform 			Yes		No	

I am satisfied that the person has the necessary
skills for such work							Yes		No	

I am satisfied that the person is fit to work and
have contact with children under the age of 12 years	          Yes		No	

I have received a statement from the person as to the
state of their physical and mental health 				Yes		No	

I am satisfied that the person is physically and mentally
fit to perform their work 						Yes		No	

I am satisfied with the identity of this person 			Yes		No	

Please tell us what documents you have seen to confirm the person’s identity
     

	

I have obtained a copy of this person’s birth certificate 
for my records								Yes		No	

I have a recent photograph of this person for my records 		Yes		No	

I have obtained two references relating to the person 		Yes		No	

I am satisfied with the authenticity of the above references 	Yes		No	

I have obtained a full employment history, together with a 
written explanation of any gaps in the person’s employment	Yes		No	

Where the person’s previous employment or position has 
Involved work with children, I have verified the reason why
the employment or position ended					 Yes		No	

If you answered no, please explain why
     

	
Please tick to confirm that you understand your responsibilities as a child minder and will ensure that every person who looks after or is intended to look after the children for whom child minding is provided, is issued with a DBS certificate allowing them to work with children.		

The registered provider needs to be able to demonstrate they have seen DBS Certificates of staff they employ and that a record is maintained for inspection by CIW.

3C  Information about any other persons (who have attained the age of 16 years and over) who work, live, or are otherwise present on the premises and who are likely to have contact with the minded children (other than any assistants named above)

A registered child minder must ensure that  every person who has attained the age of 16 and who lives or works on the premises or who is likely to have contact with the children who are to be minded must be suitable to have such contact.

Please complete the table below in respect of all persons over the age of 16 who live or work on the premises or who visit the premises and are likely to have contact with the children who are minded.

You do not need to include any persons who you intend employing as an assistant if you have already provided their details above

Full name	
Any alias and former name	
Date of
Birth
(dd/mm/yyyy)	
Address	Please specify if this person is living, working or a regular visitor to the premises
	
     

	     	     	     	     	
     

	     	     	     	     	
     

	     	     	     	     	
     

	     	     	     	     	
     

	     	     	     	     	
     

	     	     	     	     	

The following section must be completed in respect of all the people who live and/or work at the premises (listed above) who are over the age of 16 years of age. This information is requested under the Children and Families (Wales) Measure 2010 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.  A copy can be found on our website www.careinspectorate.wales
Please note: You are disqualified from registration as a child minder if any person living or working in your household is disqualified under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.

Has anyone who lives or works in your household ever:

-  Been refused registration in respect
of a children’s home or voluntary home?   Yes 	    No        Don’t know  

-  Had their registration in respect
of a children’s home or voluntary                Yes 	    No        Don’t know  
home cancelled?

-  Been concerned in the management of, or had any financial interest in a children’s home or voluntary home in respect of which another person has had their registration cancelled?                                                 
                                                                Yes     No        Don’t know  

If you answered yes to any of the above, please provide details including details of the registration authority, name and address of the home, nature of their connection with the home, type of action taken against them and the date
     

	

Has anyone who lives or works in your household ever:

-  Been refused registration in respect of 
 the provision of nurseries, day care,                    Yes        No      Don’t know 
 child minding or other provision of day care? 

-  Been disqualified from registration in 
respect of the provision of nurseries,
day care, child minding or other provision	Yes	    No	 	  Don’t know 
of day care? 

-  Had registration cancelled in respect
of the provision of nurseries, day care, 	Yes	    No 	  Don’t know 
child minding or other provision of day care?

If you answered yes to any of the above please provide details including name of the person, details of the registration authority, name and address of the provision, nature of your connection with the provision, type of action taken against them and the date
     

	

Has anyone who lives or works in your household ever

•	Been the subject of a care or supervision
	order? 					Yes        No  	   Don’t know	 

•	Had a care or supervision order made
       with respect to a child in their care? 	Yes        No  	   Don’t know	 

•	Been disqualified from fostering
	a child privately? 				Yes        No   	   Don’t know	 

If you answered yes to any of the above please provide details
     

	

Do you know of any other reason why any person who lives or works in your household may be disqualified from registration as a child minder under the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010?
								 Yes		No   

If you answered yes please provide details here
     

	
Please be aware that a failure to disclose a matter which would disqualify you from registration as a child minder may affect your ability to be granted a waiver.

   Social services check
All persons who have attained the age of 16 years and over who live or work in your household must complete the attached consent form which authorises CIW to contact social services departments for information (see Appendix 2).

Fire safety
You can seek advice and general information on fire safety matters from your local fire authority. You will have to meet any recommendations made by your fire authority (see also Appendix 3).

Environmental Health  
You can also seek advice from your local authority Environmental Health department to ensure that you are aware of, and comply with, your legal obligations under the Health and safety at Work Act (1974); the Food Safety Act (1990) and all other associated legislation. 

Family Information Service 
You should always contact your local authority Family Information Service before you apply for registration. Your local authority can provide you with information about the training and support they can offer you before you apply and once you are registered with us. The contact details for your local Family Information Service can be found here.
Disclosure and Barring Service (DBS) check
You are required to present a current DBS certificate (ie.no older than three months since date of issue) to support your application. This must be the original certificate and not a copy.

Where possible you should obtain one via your employer or umbrella body. Where this is not possible you may contact Care Inspectorate Wales on 0300 7900 126 and an advisor will give you details about how to do this. 

Guidance for Applicants is available and this will provide you with step-by-step guidance on completing your form.

Important: From April 1 2018 all applicants will be required to meet the cost of their DBS application.

Section 4 - Additional Information

Is there anything else you want to tell us to inform our assessment of your suitability (this includes any additional information about the premises and/or other people who are working or living at the premises.)
Yes		No	

If you answered yes please provide the information here
     

	

Notification of changes

Please note that you are required to notify CIW of a change in any person looking after the children on the premises and any person living or employed on those premises. The information to be provided is the new person’s date of birth, full name, former names and aliases and home address. Where reasonably practicable this information should be provided in advance of the event occurring, otherwise it must be provided as soon as reasonably practicable and, not later than 14 days after the change has occurred.

The Child Minding and Day Care (Wales) Regulations 2010 also require you to notify CIW of other specific changes to your service and significant events as prescribed in Schedule 4 of the Regulations. A 'notification' form is available on the our Internet site or from a CIW office.

This form includes a list of all the information you must tell CIW about.

               Meeting the regulations and standards

Part 2

Introduction
This section of your application is your opportunity to show that you have understood the principles and requirements expressed in the Regulations (The Child Minding and Day Care (Wales) Regulations 2010 as amended by The Child Minding and Day Care (Wales) (Amendment) Regulations 2016) and the National Minimum Standards for Regulated Child Care (NMS). You must use this part of the application form to describe the arrangements and resources you will use as a child minder to comply with the Regulations and improve your service over time.

There are eight sections to the National Minimum Standards:

•	Information on service
•	Planning for individual needs and preferences
•	Empowering service users and encouraging life style choices
•	Quality of care
•	Staffing
•	Conduct and management of the service
•	Complaints, protection and other significant events
•	The physical environment

You need to consider how you will promote equality and diversity under each of the headings above.

Each section identifies which regulations and NMS you need to meet and what information you must provide to CIW to demonstrate that you are prepared for registration as a child minder. The outcome statements under each heading should assist you to complete each section. There is also reference to additional standards shown in Annex A (Overnight care) of the NMS which you need to take account of if you intend to provide overnight care to minded children. Throughout the form where the term ‘parent’ is used it also means the ‘main carer’ of a minded child.

Family Information Service 
You should always contact your local authority Family Information Service before you apply for registration. Your local authority can provide you with information about the training and support they can offer you before you apply and once you are registered with us. The contact details for your local Family Information Service can be found here.

Section One - Information on service
Information and written contract

Relevant Regulations	

15	

Linked NMS 1 & 2

(For overnight care see Annex A)

	

Outcomes	
•	Parents have all the information they need to make an informed choice about the child care service they require

•	Parents have a written contract they have agreed with the child minder

•		

•	You must provide a written Statement of Purpose which describes your child minding business and how it will operate, providing information for anyone wishing to use your service. The content of your Statement of Purpose is prescribed in Regulation 15 and NMS 1

•	You must also provide a written contract that sets out the expectations of both child minder and parents about the care of the child, activities provided and business arrangements. You can produce your own or buy contracts from the Professional Association for Childcare and Early Years (PACEY). Make sure your contract covers all the information listed in NMS 2. An agreed and signed contract with the parent/carer for every minded child must be in place

Please tell us below how you will provide parents with this information (Statement of Purpose and contract) and how often you intend reviewing / updating this information
     

	

Please provide a copy of your Statement of Purpose

Section Two - Planning for individual needs and preferences 
Assessment, meeting individual needs and keeping records

Relevant Regulations	
15, 20, 21, 22, 23, 24, 26, 29, 30, 31, 32, 37 and Schedule 3	

Linked NMS	

3, 4 & 5	

Outcomes	
•	All children have their needs and preferences identified and their parents know how these will be met

•	Each child’s individual needs, including communication, cultural and any special educational needs and disabilities, are planned for and provided for

•	Parents and CIW have access as appropriate to a full range of records maintained by the registered child minder for the smooth running of the child 

•	minding service	

•	The assessment: you must develop a form to use with parents that will make sure you understand each minded child’s needs, what parents expect from you and confirmation that you are able to meet these needs and expectations

•	You must prepare a policy that describes how you will assess, plan for and meet any communication, cultural, special or additional needs minded children may have and include how you will make sure that any assistant you employ will also meet this standard

•	You must ensure that you keep records as required by Regulation 30 and Schedule 3 of the Child Minding and Day Care (Wales) Regulations 2010

Please tell us below:

•	What you would assess with parents to ensure that you will be able to meet each child’s individual needs and preferences
•	How you will ensure that childrens’ home language is given due consideration and children are provided with opportunities to use and experience the Welsh language, traditions and cultural celebrations 
•	How you intend to promote the development of all children by planning for a good variety of play, learning, recreational and leisure opportunities
•	How you will track the progress of children up to eight years and use information and observation to plan for the next steps in their play and learning
•	How you will ensure that children over eight years are able to determine and control the content of their play by following their own ideas and interests
•	 How you will ensure information about each child is kept up-to-date
•	How you will store these confidential records and, where required, make them available
     

	

Please provide a copy of your special needs policy

Section Three - Empowering service users, encouraging life style choice
Working in partnership with parents and opportunities for play and learning

Relevant Regulations	

16, 20, 27, 32, 37	

Linked NMS	6 & 7
including Annex A a.9 & a.10 if appropriate	

Outcomes	
•	Parents are kept fully involved in and informed about their child’s activities, achievement and progress

•	Children have a range of experiences - including freely chosen, unstructured and self directed play - that contribute to their emotional, physical, social, intellectual, language and creative development

•		

Parent’s primary responsibility for their children must be recognised and respected. They must be kept fully informed about the child minder’s routines and child care practices.

Please tell us below how you will:

•	Keep parents informed and involved in the care of their child

•	Seek feedback from parents about the service you are providing

•	Demonstrate a good understanding of the importance of play and the different types of play for the age ranges of children you care for

•	Listen to children and value their contribution 

•	Ensure children can influence the activities and tasks they do

•	Promote a sense of fun and enjoyment

•	Ensure children have access to furniture, equipment, toys and materials that are appropriate and suitable for their needs 

•	Help children to cope with new situations; to freely explore their environment and use their imagination 

•	Manage risk and ensure there is a clear understanding of the difference between acceptable and unacceptable risk for the age group of children using the service  

•	Ensure that access to toys, electronic games, DVDs and the internet is well monitored to ensure they are appropriate to the children’s age and stage of development

•	Ensure children have the opportunity to show or talk about what they have been doing

Also describe what specific resources, play opportunities and activities you intend to provide

     

	

Please provide a copy of your confidentiality policy

Section Four - Quality of care
Nurture and wellbeing, behaviour, health care, medication and food and drink

Relevant Regulations	
20, 21, 23, 24, 25,
26, 27, 29, 30,
31 37	
Linked NMS	8, 9, 10, 11 & 12 including Annex A
a.8 and a.9 if appropriate

Outcomes	
•	Children feel secure, happy and comfortable with their carers and in their environment and their rights are respected

•	The behaviour of children is managed in a way that respects their rights and promotes their welfare and development

•	The health care needs of each child are identified and addressed as appropriate and children benefit from the way in which good health is promoted

•	Children are safeguarded by the setting’s policies and procedures about medication, and receive the medication they need

•	Children are provided with regular drinks and food in adequate quantities for their needs	

You must prepare the following:

•	A written behaviour management policy stating the methods used to manage children’s behaviour: this should include a statement on how you will deal with bullying
•	A written policy describing your procedure and management for storing and administering medication
•	A written procedure that describes what action you will take if a child becomes lost/missing or is not collected

You must:

•	Hold and maintain a qualification in first aid for infants and  young children and keep a first aid box
•	Keep a record of any medicine administered to a child
•	Prepare a form for parents to give their consent for you to give medicine to their child
•	Contact the Food Standards Agency in order to register with them, if you are providing food for minded children
•	Contact your local authority Family Information Service to arrange training in basic food hygiene; this is good practice

We advise that you plan a healthy eating menu for the children in your care taking account of NMS 4

Please tell us in the box below how you would:

•	Promote understanding of child development and how this impacts upon children’s behaviour
•	Encourage all children to co-operate, share, understand accepted rules of behaviour, how to relate to others, contribute to decision making and become self-disciplined
•	Manage children’s unacceptable behaviour and tackle any instances of bullying

•	Raise any concerns with parents about a child’s behaviour and work together to implement ways to manage unwanted behaviour

•	Promote good health of the children you look after and prevent the spread of infection and what you would do if any child is ill and/or has to be excluded due to illness

•	Record a child’s health needs and any observations or concerns you may have and how these will be raised with parents

•	Identify the risks around the administering of medication and how you would seek advice and training if required

•	Respond  to any medical emergencies

•	Manage mealtimes, provide a balanced and nutritious diet that takes account of individual  needs, preferences and any food allergies

	     

	

Please provide copies of your:

•	Behaviour management policy
•	Medication policy
•	Lost/missing/not collected procedure
•	Current certificate in first aid for infants and young children
•	
Section Five - Staffing
Suitable Person

Relevant    Regulations

6, 9, 27, 28, 29	Linked NMS	13 (CM)	

Outcomes	
Children’s needs are fully met by those who look after them.	

•	A child minder must be suitable to look after children under the age 12 years: you are asked to provide evidence of this in Part 1 of this application
•	You must notify CIW should you wish to employ an assistant to look after children. Child minders are always responsible for supervising assistants during working time: you should be aware of any relevant employment law that applies to this part of your business
•	If you employ any assistants you must prepare a written policy and procedure for staff discipline.

Please provide information below about:

•	Your knowledge of child development and how you propose to keep up-to-date with
	any changes in this area

•	Your arrangements for supervising/training any assistants (if applicable)

•	How you would ensure that everyone understands their roles and responsibilities with regard to safeguarding, promoting healthy lifestyles, personal care, personal safety and relationships
     

	

Please provide the following:

•	A copy of your pre-registration qualification certificate
•	Written policy and procedure for staff discipline (if applicable)

Section Six - Conduct and management of the service
Organisation, staffing ratios, equal opportunities, financial procedures and quality assurance

Relevant Regulations	
6, 9, 15, 16, 17, 18, 20, 27, 28, 32, 33	
Linked NMS	
14, 15, 16, 17, 18

Outcomes	
•	Parents and children benefit from a well organised and planned child minding service
•	Children benefit because the ratio of adults to children conforms to best practice
•	All children are treated with equal concern and respect
•	Children and their parents are safeguarded by the registered person operating sound financial procedures
•	Children and their parents benefit from a quality service that is effectively monitored.	

You must:	

•	Have appropriate public liability insurance.  (Schedule 2 Part 1 Paragraph 18)
•	Set up and keep a system for monitoring, reviewing and improving the quality of care given to children (Regulation 16). The quality of care must be reviewed annually and you must obtain the views of children, parents and other significant persons.  You will be required to complete a Self Assessment of Service Statement (SASS) form, which is issued by CIW every year (Regulation 17). This will be accepted as your annual review of quality of care providing it meets the requirements of Regulation 16 and is in such a format that can be understood by parents and other significant persons.

CIW may make requirements about your service - you must let CIW know that you have completed them by the given date (Regulation 18).

You should:

•	Prepare a written policy that explains how you promote equality of opportunity and anti-discriminatory practice (NMS 16.2)
•	Develop and periodically review an operational plan which indicates the number of children you will care for and your emergency cover arrangements (NMS 14.1)
•	Ensure that your car is roadworthy and that you have appropriate car insurance which includes business use, if you intend to use your car for child minding
•	Keep a record of all financial transactions for your business. It is good practice to make enquiries with your local Tax Office to check what records they will expect you to keep.

Please tell us below:

•	How you will ensure that your service complies with relevant regulations and National Minimum Standards

•	How you will continue to keep up to date with current best practice relevant to children in your care

•	About the activities and resources you will develop and use to help children understand and learn about a wide range of people and cultures in our society

•	How you will monitor the quality of your service and seek the views of minded children, parents and other interested parties on the quality of care you provide

     

	

Please provide a copy of the following:

•	Your operational plan
•	Your equal opportunities policy

Section Seven -	Complaints, protection and other significant events
Complaints, safeguarding/child protection, notifying CIW of changes/significant events

Relevant Regulations	
10, 11, 15, 22, 23,
28, 31, 32, 33, 34, 35, 36	

Linked NMS	

19, 20 & 21	

Outcomes	
•	Children and their parents are confident that their complaints will be listened to, taken seriously and acted on

•	Children are protected from harm and abuse and parents are confident that all reasonable steps to protect children from abuse are taken.	

You must:

•	Have a written complaints procedure in line with the Regulations which informs parents how you will deal with any concerns they have and what you will do if they are not satisfied (Regulation 32)
•	Keep a record of all complaints. (Regulation 33(5))
•	Ensure parents are aware that CIW is the organisation that registers and inspects your service and give parents the contact details for the local CIW office. (Regulation 32(6))
•	Provide a written child protection policy that links into the arrangements of the Safeguarding Children Board (LSCB) and identifies how to access the All Wales Child Protection Procedures. The policy must include local contact telephone numbers for reporting concerns you might have about a child in your care. (Regulation 22)
•	Notify CIW of the occurrence of any of the events listed in Schedule 4 of the Child Minding and Day Care (Wales) Regulations 2010 and other requirements for notification e.g. if you as a child minder are convicted of a criminal offence.  A notification form which lists all notification requirements is available on the CIW Internet site.

Please tell us below:

•	How you would ensure that children know how to raise their concerns/complaints and are supported to do so in a safe environment
•	How would you deal with a concern or complaint from a parent?
•	How you would ensure that lessons are learnt and appropriate action is taken in relation to any concerns or complaints made about the service
•	How would you deal with a potential child protection issue, including allegations made against someone who visits your home; someone you employ; yourself or a family member?
     

	

Please provide the following:

•	A copy of your complaints procedure
A copy of your child protection policy.

Section Eight - The physical environment
Environment, equipment and safety

Relevant Regulations	
20, 25, 37, 38

Linked NMS	
21, 22 & 23	

Outcomes	
•	Children are cared for in an environment that is safe, secure and suitable for their purpose
•	There is sufficient space to meet the needs of all children using the service
•	Children have access to furniture, equipment, toys and children are cared for and have their needs met in a safe environment that includes indoor and outdoor play areas 

You must ensure:

•	That safety is promoted and all precautions are taken to prevent accidents
•	Hazards for children are kept to a minimum and Health and Safety Regulations are complied with
•	an up to date risk assessment of the premises in place
•	premises you use are compliant with fire safety requirements. 
•	A fire safety checklist is available in Appendix 3

You must develop and provide an emergency evacuation procedure for the premises.

Please describe below

•	How you will ensure that the layout and design of the environment promotes childrens’ independence and is considered from a child’s perspective
•	How you will ensure the premises and any outside play areas are secure, welcoming, friendly and provide a rich environment for play and learning
•	The safety measures you have put in place for each area of the premises (indoor and outdoor space) to be used for child minding
•	How you will ensure children are adequately supervised at all times (this includes trips away from the premises)
•	How you will ensure that furniture, equipment and toys are well maintained and conform to BS EN safety standards or relevant Toys (Safety) Regulations
•	How you will ensure that cleaning routines reflect good hygiene practices and effective infection control
•	How you will ensure that everyone is aware of their responsibilities in relation to the safety and welfare of children; that everyone understand health and safety requirements applicable to the service and follow the service’s related policies and procedures
     

	

Please provide copies of your:

•	Risk assessment of the premises
•	Annual safety check for gas/electrical/oil burning appliances
•	Statement of the procedure to be followed in the event of a fire or accident

Checklist of documents to be submitted with your application

Please tick to confirm that you have attached a copy of the following:

Your birth certificate                                                                                                          

Proof of identity                                                                                                                 

A recent photograph                                                                                                         

Certificates of your qualifications that are relevant to looking after children 
under the age of 12 years, or other suitable evidence                                                     

Copy of your pre-registration qualification (Introduction to Child Minding Practice)         

Copy of your current certificate in first aid for infants and young children                        

Medical practitioner report or, if unobtainable, a statement from you as to the 
state of your physical and mental health                                                                           

Your DBS certificate (this must be the original certificate and no more than three 
months old since the date of issue)                                                                                 

A valid DBS certificate for all persons who have attained the age of 16 years and over; 
who live or work in the applicant’s household or are likely to have contact with the 
children                                                                                                                                  
                           
Plan of the home where you will be child minding                                                             

Letter from your landlord confirming consent to mind at the premises (if applicable)        

Social Services enquiry consent form                                                                                

Please also provide copies of the following policy documents:

Your Statement of Purpose                                                                                                

Your child protection policy                                                                                                 

Your behaviour management policy                                                                                   

Your staff disciplinary procedure, if applicable                                                                   

Statement of the procedure to be followed in the event of a fire or accident                     

Your procedure for dealing with a child who is lost/missing/not collected                         

Your complaints procedure                                                                                                

Your special needs policy                                                                                                  

Your medication policy and procedure                                                                              

Your equal opportunities policy                                                                                         

Your confidentiality policy                                                                                                  

Risk assessment for your premises                                                                                   

Annual safety checks gas/electric/oil                                                                                 

Please ensure you have signed and dated the application.

Failure to provide all the required items and a fully completed application form will lead to your application being returned or refused.

Important: All childcare providers must comply with other relevant legislation including that which covers for example, health and safety; disability discrimination; food hygiene; fire and planning. 

Failure to comply with other relevant legislation may be considered by CIW in relation 
to your fitness as a registered person.

Declaration
I am applying for registration as a child minder and certify that the information given in this application is true and accurate to the best of my knowledge and belief. I understand that it is an offence to knowingly make a statement which is false or misleading and to do so may lead to prosecution and/or the refusal or subsequent cancellation of my registration.
In making this application for Registration under the provisions of the Children and Families (Wales) Measure 2010 I agree to comply with the Child Minding and Day Care (Wales) Regulations 2010 as amended by the Child Minding and Day Care (Wales) (Amendment) Regulations 2016 taking into account the National Minimum Standards for Regulated Child Care.

I agree to Care Inspectorate Wales undertaking whatever checks it deems necessary to verify my suitability.

Important: 
We process any personal and/or sensitive information we hold about you fairly and lawfully, and we only ask for such information where it is necessary for us to carry out our role. For more information about how we process your personal data, and your rights in relation to this, please see our Privacy Notice at https://careinspectorate.wales/how-we-use-your-information, or contact us for a paper copy.

Applicant’s Signature:	     	
Date:	     

You are advised to keep a copy of this form for ongoing reference and guidance.

Appendix 1: Medical Reference:

Medical reference for Care Inspectorate Wales in respect of a person applying to be a Child Minder or Day Care provider
This section to be completed by the applicant:
Name and address:	     	

Post code:	     	

Tel No:	     	

E-mail:	     	

Date of birth:
(dd/mm/yyyy)	     	

Place of birth:	     	

Maiden name:	     	

Any other surname:
	     	

This section to be completed by the applicant’s GP:
Name:	     

Address:	     	

Post code:	     	

Tel No:	     	
Note to GP
Before completing the declaration below, please consider any existing medical condition for which the applicant is being treated at the moment and any hospital admissions over the last five years which may be relevant.

It is my opinion that after reading the medical notes of:	     

The applicant is physically and mentally fit to look after children under the age 12 years 

OR

The applicant has a condition or disability (including mental disability) which may     
 affect his/her ability to look after children under the age of 12 years	                           	
GP Signature:
	     

	    Date:	     	

Surgery Stamp:

Appendix 2: Social Services Check Consent Form

	
Declaration and consent for CIW to contact Social Services Departments
This form is also available as a separate document on the Care Inspectorate Wales website (https://careinspectorate.wales).

Regulation and Inspection
Children and Families (Wales) Measure 2010 as amended by The Regulation of Child Minding and Day Care (Wales) Order 2016 and the Child Minding and Day Care (Disqualification) (Wales) Regulations 2010.

A copy of this form must be completed by the applicant and all persons who have attained the age of 16 years and over who live/work in the applicant’s household.

Full name and address of applicant/person who has attained the age of 16 years and over who lives/works in the household:	     	

Any alias and former names:
	     	

Postcode:	     	

Date of birth:
(dd/mm/yyyy)	     	
      Previous full addresses in the last five years:
Address 1:	Address 2:	
     	     	
Postcode:	Postcode:	
     		     	
From:	     	Until:	     	       From:	     	  Until:	     	

Address 3:	Address 4:	
     	     	
Postcode:	Postcode:	
     		     	
From:	     	Until:	     	       From:	     	  Until:	     	

Address 5:	
     	
Postcode:	
     	
From:	     	   Until:	     	

Have you ever been the subject of a care or supervision order? 	Yes		No	

Have you had a care or supervision order made with respect 
to a child in your care? 							Yes		No	

Have you ever been disqualified from fostering a child privately? 	Yes		No	

If yes to any of the above, please provide details including dates and the local authority involved
     

	

Please give the following details of children who currently live with you and of those who may now live elsewhere (including those of your partner)

Full name of child	
Date of birth
(dd/mm/yyyy)	
Relationship to you	
     
	     	     	
     
	     	     	
     
	     	     	
     
	     	     	
     
	     	     	
     
	     	     	
     
	     	     	
     
	     	     	

I confirm that the information provided above is correct and I give my consent to Care Inspectorate Wales contacting my local or any relevant Social Services Department so that the above statements may be verified and to share any other information relevant to my suitability to care for children under the age of 12 years.

Name:
	     

	Date:	     	

Signature:
	
     

Personal information
We process any personal and/or sensitive information we hold about you fairly and lawfully, and we only ask for such information where it is necessary for us to carry out our role. For more information about how we process your personal data, and your rights in relation to this, please see our Privacy Notice at https://careinspectorate.wales/how-we-use-your-information, or contact us for a paper copy.

Please return this form to your nearest CIW office with your application form.

Appendix 3: Child Minder Fire Safety Checklist

Fire Safety Checklist

The following information is intended to help you to make sure that fire safety matters have been dealt with by you before the CIW inspector visits your home.  Please have this form available when the inspector visits your home.

Applications for the registration of a child minder will not normally be referred to the fire service unless overnight care is to be provided.

All the boxes below should be completed and this will help the inspector make a judgement as to whether they need to make contact with the fire service.

Should an inspection reveal matters of concern regarding fire safety, CIW will contact the local fire service for discussion. If it is decided that the fire service need to inspect the premises, a request will be put in writing by CIW.

Please complete the following checklist:

Is any overnight care to be provided for minded children?                Yes		No   

Is there a smoke alarm on each floor to be used for 
child minding?                                                                                               Yes 	 No  

Can the sound of any one smoke alarm be heard in all areas used 
for child minding?                                                                                  Yes	 	  No  

Is any accommodation provided for child minding above
the ground floor?                                                                                                                                                        Yes		  No  

If yes, how many floors above ground level do you intend using?		     

Do the stairs come down to a passageway that leads to an 
exit door?                                                                                      Yes	 	  No  

(If for example the stairs come down into a living room then it will probably not be acceptable and a referral may need to be made to the fire service by CIW or you may need to consider restricting the use of certain rooms.)

Is a basement to be used for child minding?                                         Yes	 	   No  

If so has it got an alternative way out?                                                  Yes	 	   No  

Is the way out easily used in the event of an emergency?                   Yes		   No  

Is there anything unusual about the layout of the home?                 Yes		   No  

Do you have a BS Kite mark fire blanket?                                            Yes		   No  

Where is this fire blanket located?	

Are all forms of heating guarded as appropriate?                               Yes	      No 

Are there adequate arrangements to control risk from cooking 
areas? (Consider use of kitchen while child minding.)		    Yes		No  

Are adequate arrangements in place to separate children 
from smokers’ materials?						    Yes  	No  

Does the furniture comply with the Furniture and Furnishings
Regulations 1989 and is it in good condition?			    Yes  	No   
(Check there are labels underneath sofa cushions, no foam/filling 
visible) 

Make a note here if you have any fire safety concerns or wish to discuss this further with an inspector