FAIRFAX COUNTY , VIRGINIA FAMILY SERVICES OFFICE FOR - fairfaxcounty 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A. Fill in your Provider Name, including Last, First, and Middle names. Provide your contact information such as phone number and email address.
3. Indicate whether this is an initial application or a renewal by checking the appropriate box. Include the Home Child Care Facility Address if different from your own.
4. Complete the proposed hours and days of operation. Specify your race (ethnicity) and birth date.
5. Answer the questions regarding your Fairfax County Child Care Permit status by checking 'Yes' or 'No'.
6. Move to Section B and list all children aged 13 years and under living at home. Provide their names, sex, race, and birth dates.
7. In Section C, complete information for all adults and children aged 14 years and older living at home or regularly in contact with the children.
8. Proceed to Section D for Criminal History Records. List all adults (18 years and older) living at home along with their details.
9. Finally, sign in Section E to confirm your application submission and date it accordingly.

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