Home
Parents
Children's Health & Development
Children’s Growth and Development
Social and Emotional Supports
IDEA Individuals with Disabilities Education Act
Healthy for Life
Child Care Options
Types of Child Care
Finding a Nanny or a Babysitter
Summer Camps
Out of School Time Care
Choosing Quality Child Care
What Does Quality Look Like?
Selecting a Provider
Phone Pre-Screening Tool
Infant & Toddler Quality Checklist
Preschool Quality Checklist
School Age Quality Checklist
Child Care Checklists
Health/Safety Checklist
Infant & Toddler Quality Checklist
Preschool Quality Checklist
School Age Quality Checklist
Site Visit Checklist
Preparing Your Child for Child Care
Options to Help You Pay
Tips For a Successful Arrangement
Licensing
Accreditation
Providers
Becoming a Child Care Provider
Training & Professional Development
Fingerprints
Quality Improvement
Resources for Providers
Provider Portal
Reports
Average Child Care Cost
Annual Child Care Capacity, Availability and Enrollment Survey 2019
Annual Child Care Capacity, Availability and Enrollment Survey 2020
Number of Deaths, Serious Injuries, Substantiated Child Abuse & Neglect in Child Care Settings
Child Care Program Closure Report
Search for Child Care
Announcements
Contact Us
DCF Form (espanol)
Authorization for Release of Information from DCF (Dec 2021)
"
*
" indicates required fields
1
Attestation
2
Child Care Experience
3
Your Information
NOTE: This form must be completed by each employee or volunteer of a childcare facility, Care 4 Kids youth camp, and each member of a family child care provider’s home who is 16 years of age or older before a background check may be processed by OEC.
Legal Name
*
First
Middle
Last
Attestation
*
I do hereby authorize the Connecticut Department of Children and Families (DCF) to research their records for any and all information concerning charges, findings, dispositions, etc., relating to child abuse and/or neglect, in which I have been named, and to release this information in whole to the Office of Early Childhood (OEC) for the purpose of completing a comprehensive background check. I further authorize the OEC to release any final DCF substantiations of abuse or neglect which resulted in my placement on the central registry to the Director/Operator or other designee of a child care facility for purposes of determining my eligibility for employment, OR assessing my household environment based on an individual 16 years of age or older who resides in my household that is used as a family child care home. I release the DCF and OEC from all liability for any damages I may incur, which may result from the release or use of this information. I submit the information below to assist DCF in their research. This release is valid for a term of five years from the date of signature unless rescinded in writing.
I do hereby authorize
Within the last 180 days
*
I was employed in a child care facility
I resided in a family child care home
I have not been employed in a child care facility or resided in a family child care home
Name of Family Provider, Center or Camp
*
Your Role
*
Center (Staff / Volunteer / Prospective)
Family Provider / Staff / Volunteer
Family Household Member
Group Home (Staff / Volunteer / Prospective)
Unlicensed Care 4 Kids Provider
Please provide the license number for the program where you are currently employed/volunteer or will be employed/volunteer
Please provide the license number for the family child care home
License Number
*
Your Date of Birth
*
MM slash DD slash YYYY
Gender
Female
Male
Your Telephone Number
*
Other names you have used
(maiden, married, nickname, etc.)
Your Email
*
Your Current Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Hidden
Your Current Full Address
*
Have you lived at this address for the last 5 years
*
Yes
No
Date you started living at this address
*
MM slash DD slash YYYY
Your previous residence(s) for the last 5 years
*
Please list your previous addresses starting with your most recent previous address first. You need to ensure you account for the last 5 years. Use the + sign to add additional residences.
Number and Street
City
State
Zip
Start Date
End Date
Add
Remove
Example of Residence for the last 5 years
Number and Street
City
State
Zip
Start Date
End Date
1455 Nathan Hale Blvd
Newington
CT
06111
Aug 2017
Aug 2018
125 Juniper Berry Lane
Hebron
CT
06248
Jan 2016
Aug 2017
247 125th St
Hartford
CT
06106
Oct 2011
Jan 2016
Δ
×
Translate »