Request Child Care Form

There are several ways for families to receive free referrals from Child Care Aware of Virginia.

  1. You can conduct your own referral search on-line.
  2. Call (866) 543-7852 option 2 for our customized referral service
  3. Complete our on-line form below

This online form once completed and submitted will be sent directly to our Consumer Education Specialist.  Once the form is received your search will be conducted no later than the next business day.  You will receive an email with information on child care programs that meet your needs along with additional information in choosing a quality child care site.

All fields marked with “*” must be completed before this form can be submitted.

Child Care Search Form

Form for parents to submit when looking for child care
  • Search Criteria

  • Demographic Information