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Home Child Care Facility Permit Application

Complete the requested information.

• A processing fee of $14 is required with each application.
• The fee can be paid by PERSONAL CHECK, MONEY ORDER or CERTIFIED CHECK.
• Make payable to the OFFICE FOR CHILDREN.
• The application fee is not refundable.

 

• Home Child Care Facility Application - English Version (PDF)
• Home Child Care Facility Application - Spanish Version (PDF)

Criminal History Compliance Statement

Complete this form by answering "YES" or "NO" to the question. Sign and date next to your answer. Each adult, 18 years or older, who lives in the home, or any other adult who may come in contact with the children, including child care assistants, must complete this form.

• Criminal History Compliance Statement - English Version (PDF)
• Criminal History Compliance Statement -Spanish Version (PDF)

Family Services/Office for Children Consent for Release of Information

This form must be completed (signed and dated) by you and each person, 14 years or older, who lives in the home and by any other person 14 years or older who may come in contact with the children, including child care assistants.

• Consent for the Release of Information (PDF)

Child Protective Services Release of Information

A separate form must be completed by each person, 14 years or older, who lives in the home where child care will be provided, or by any adult who may come in contact with the children, including child care assistants. Use full names, not initials.

• If there is no middle or maiden name, write "NMN" in the space.
• This form must be notarized (on the back).

• Request for the Central Registry and Release of Information (PDF)

Criminal History Record Request

Each adult, 18 years or older, who lives in the home, or any other adult who may come in contact with the children, including child care assistants must complete this form.

• A processing fee of $15 per adult is required.
• The fee can be paid by PERSONAL CHECK, MONEY ORDER or CERTIFIED CHECK.
• Make payable to the OFFICE FOR CHILDREN.
• The application fee is not refundable.

• Criminal History Record Request (PDF)

Provider Child Care Central Website Application

This form will allow your name to be listed on the Office for Children Child Care Central 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)

Provider Fire Drill Record

The Fairfax County Fire Department requires permitted providers to present this document at renewal time. This form can be used to record monthly fire drill practices.

• Fire Drill Record (PDF)

  

MAIL ALL COMPLETED FORMS AND FEES TO: Fairfax County Office for Children Division of Community Education and Provider Services 12011 Government Center Parkway, Suite 800 Fairfax VA 22035-1102 CALL 703-324-8100 FOR ASSISTANCE.