Business Forms for Family Child Care Providers
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Child Care Database
Sample Child Care Agreement Form
This form outlines policies and procedures that parents must agree to when enrolling children in a family child care program. You can modify this agreement to fit your own business.
Sick Child Policy
Sick children who attend child care programs while they are contagious can make others sick. Parents must sign this form agreeing to not bring sick children in for care and to remove sick children from care as soon as possible.
Administering Prescription or Nonprescription Medication Record
By law, you must complete medication administration training in order to legally give medication to children in your care. You can use this form to document medication parents have authorized you to give their children. You can create your own form, but you must keep a record of any medication you administer.
Child File Form
This form helps you gather and organize important information needed for each child in your care.
Family Information and Emergency Contacts Form
This is a form parents fill out so that you will know how to reach them during an emergency. It also lists the people they have authorized to pick up their children from your program.
Emergency Response Template
You are required to have a written emergency plan that covers evacuation plans, emergency preparedness plans and parent notification plans. You can create your own form or use this one.
Injury or Accident Report
You can use this form to document injuries that occur to children while in care.
Authorization for Emergency Medical Treatment Form
Parents fill out this form to authorize you to take their child to the hospital or urgent care facility if the parents cannot be reached in time. It also includes information that will be useful to the medical professionals treating the child.
Evacuation/Fire Drill Form
Use this form to document monthly drills. You will be required to present it when you apply for your permit renewal.
Monthly Shelter-in-Place Drill Form
If there is a community emergency, officials may tell residents to "shelter in place." Each month, practice moving the children quickly into the shelter-in-place. Use this form to record the results of your practice drills. The shelter-in-place in your home should have the food, equipment and supplies in this Emergency Preparedness and Supplies Guide.
Change of Adults Living in Your Home
If anyone age 18 or older moves into your home after you have received your child care permit, submit sections C, D and E of the Home Child Care Facility Application form English or Spanish to the Office for Children. You must also submit a Sworn Statement or Affirmation for Child Day Programs form English or Spanish and a Child Protective Services Central Registry Release of Information form. To request a copy of the CPS Release of Information Form in English or Spanish, please email Tammi Daniels or call 703-324-8100, TTY 711. Mail all three forms to: The Fairfax County Office for Children, Community Education and Provider Services, 12011 Government Center Pkwy., Suite 800, Fairfax, VA 22035.
USDA Food Program
Family child care providers who participate in the USDA Child and Adult Care Food Program must post one of these flyers (English) (Spanish) and posters (English) (Spanish) to notify parents that the provider particpates in the program.