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Family Child Care Provider and Child Care Center Web Site Applications |
This form will allow your name to be listed on the Office for Children Web site after you have received your Family Child Care Permit.
- Center Child Care Central Database Application (PDF)
- Provider Child Care Central Database Application (PDF)
- Solicitud para ingresar a la Base de Datos Central (PDF)
Sample Child Care Agreement Form |
This form is a resource for you as you create your own Family Child Care Business contract. You will want to customize this agreement to fit your business.
Family Information and Emergency Contacts Form |
This form provides information to reach a parent or an emergency contact person. It can also be used to designate who is authorized to pick up a child from your care.
Authorization for Emergency Medical Treatment Form |
This form is signed by the parent or legal guardian and gives the hospital permission to give emergency treatment to a child. It also includes other helpful information to the hospital and the provider to provide care to an injured or sick child.
Injury or Accident Report |
You can use this form to document when an injury occurs to a child while in your care.
Administering Medication Form |
You can use this form to document medication, prescription or non-prescription, that a parent authorizes you to give to their child. You can create your own form, but must keep a record of any medications you administer to children.
- Administering Medication (PDF)
Provider Fire Drill Form |
The Fairfax County Fire and Rescue Department requires permitted providers to present this document at renewal time. This form can be used to record monthly fire drill practices.
Shelter-in-Place Drill Form |
| If there is a community emergency, officials may tell residents to "shelter in place." The "shelter-in-place" in your home should have the food, equipment and supplies in this checklist. Each month, practice moving the children quickly into the shelter-in-place. Use this form to record the results of the practice sessions. |
Change of Adults Living in Your Home |
| Forms must be submitted for each adult -- anyone who is 18 years old or older -- living in your home. If an adult moves into your home after you have received your child care permit, complete sections C, D and E of the Home Child Care Facility Application Form (PDF). You must also complete this child protective services form (PDF). |
Mail both forms to: The Fairfax County Office for Children, Community Education & Provider Services, 12011 Government Center Pkwy., Suite 800, Fairfax, VA 22035.