For Your Information

If none of the Registration Types listed apply to you, select "Voluntary."

If you do not list all other known names used, including both first names and last names, your registration may be rejected.

Enter the Registrant's home address.  If the Employer's address is used, your registration will be rejected.

Questions? Call the FCSR toll-free at (866) 422-6872.

  PERSONAL INFORMATION
Welcome to Registration Information Is A Person Registered Employer Information Register

Selection Criteria

   *Registration Type(s):

 
Adoptive Parent
 
Child Care
 
Foster Parent / Family Member of Foster Parent  
 
Hospital
 
Long Term Care / Personal Care
 
Mental Health / Psychiatric Hospital
 
Voluntary


Personal Information

 

*Last Name:

*First Name:

Middle Name:

Suffix:


 
Add Other Name
  If you do not list all other known names used, including both first names and last names, your registration may be rejected.

 
Month
Day
Year *Gender:
*Date of Birth:        


Contact Information

  Registrant Mailing Address: Enter the registrant's home address.  If the employer's address is used, your registration will be rejected.
  *Street Address or PO Box:
 
  *Zip Code:
*City:
*State:
  *County:
   
  Telephone:
     
  *Registrant's Email:
An email address is required for individuals registering online. This should be a personal email address that belongs to the registrant. Correspondence will be delivered via secure email.
  *Confirm Email:
 


 
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*Indicates a Required Field
Messages

Click Continue Button after Required Information Entered to Proceed with Registration