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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 -- Providers (PDF)
- Center Child Care Central Database Application -- Centers (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 or any adult who may regularly come into contact with the children. 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 a Sworn Statement or Affirmation for Child Day Programs form (PDF) and a Child Protective Services Central Registry Release of Information form. (PDF) |
Mail all three forms to: The Fairfax County Office for Children, Community Education & Provider Services, 12011 Government Center Pkwy., Suite 800, Fairfax, VA 22035.
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