Tennessee child care, camp and ratio rules

Child care licensing

A program needs a TDHS license if it provides care for 3 or more hours a day to 5 or more children who are not related to the caregiver. Family child care homes care for 5-7 children, group child care homes for 8-12, and child care centers for 13 or more (Rule 1240-04-01-.02; T.C.A. §71-3-501 et seq.).

After-school and recreation programs: Programs, such as after-school programs, that do not care for 5 or more unrelated children for 3 or more hours a day do not need a license. School-administered preschool and school-age programs are regulated by the Department of Education instead of TDHS. Other exemptions include recreational programs, camps that run only in summer (under 90 days a year) or only during school breaks, Boys & Girls Clubs, and YMCA school-age programs. Most exempt programs must register with TDHS, get written approval before operating, post a sign saying they are not licensed, and keep attendance records (T.C.A. §71-3-503, as amended July 1, 2025).

Licensing agency: Tennessee Department of Human Services (TDHS), Child Care Services

Sources: Rule 1240-04-01, Licensure Rules for Child Care Agencies (TN Secretary of State, Feb 2026); T.C.A. §71-3-503, exemptions as amended July 1, 2025 (TDHS); TDHS: Procedures for Requesting an Exemption from Licensure

Staff-to-child ratios in licensed centers

Rule: Tenn. Comp. R. & Regs. 1240-04-01-.22(1)(c), Chart 1 (rules revised February 2026). School-age groups have no maximum group size. Chart 2 sets mixed-age ratios, for example 1:13 (group of 24) for 3-5 years and 1:20 for 5-12 years. Chart 3 allows larger combined groups during the first and last 1.5 hours of the day. Centers may exceed ratios and group sizes by up to 10% no more than 3 days a week, but never for infants or toddlers. When more than 12 children in first grade or above are present, they need their own educator, group, space, and program.

Work out your staffing with the ratio calculator

Summer camps

An organized camp needs a Department of Health permit before it opens (T.C.A. §68-110-103; Rule 1200-01-05). The permit covers health and sanitation, such as facilities, water, and sewage, rather than program staffing. The rules cover camps with outdoor group living or sleeping quarters and define a day camp as an organized camp program. Separately, a camp that meets the legal definition of child care is exempt from a TDHS license only if it runs in summer (under 90 days a year) or during school breaks, serves school-age children, registers with TDHS, and has written approval to operate (T.C.A. §71-3-503(b)(9)).

Camp agency: Tennessee Department of Health, Environmental Health Program (inspections by local health departments)

Sources: TN Department of Health, Environmental Health (Organized Campgrounds); Rule 1200-01-05, Organized Camps (TN Secretary of State); T.C.A. §71-3-503 exemptions (TDHS)

Background checks

Owners, operators, directors, employees, substitutes counted in ratio who work more than 36 hours a year, and household members 15 or older need a fingerprint-based criminal background check and a registry review no more than 90 days before they have access to the agency. The registry review covers the Vulnerable Persons Registry, the sex offender registry, and Department of Children's Services abuse/neglect records. Checks must be repeated at least every 5 years and after a break in child care employment of more than 180 days. No one may have unsupervised contact with children until cleared (Rule 1240-04-01-.07; T.C.A. §71-3-507). We did not find a separate state background check requirement for youth camps.

Sources: Rule 1240-04-01-.07 (TN Secretary of State, Feb 2026)

Giving medication

A designated staff member must accept medication from the parent, get written parent authorization for each medication, and confirm that it is in its original container, not expired, and labeled with the child's name. Only staff trained in medication administration may give it, and each dose is documented (time, amount, side effects, staff name) with a copy to the parent. Medication is stored in a child-proof container, though emergency medications such as an EpiPen or inhaler may be kept unlocked out of children's reach (Rule 1240-04-01-.12(12)).

Free medication administration log

Sources: Rule 1240-04-01-.12(12) (TN Secretary of State, Feb 2026)

Reporting child abuse

Everyone in Tennessee is a mandated reporter and must report suspected child abuse or neglect immediately (T.C.A. §§37-1-403 and 37-1-605). Child care rules make each owner, director, staff member, substitute, and volunteer personally responsible for reporting. Staff may not wait to investigate first, and a program may not have policies that get in the way of reporting (Rule 1240-04-01-.10).

Tennessee child abuse hotline: 1-877-237-0004 (how to report). In an emergency, call 911.

Sources: TN Department of Children's Services: Report Child Abuse; Rule 1240-04-01-.10, Duty to Report (TN Secretary of State, Feb 2026); Child Welfare Information Gateway: Mandatory Reporting of Child Abuse and Neglect