Dss Form 2900 – Fill Out and Use This PDF

The DSS 2900 form is an essential document designed by the South Carolina Department of Social Services for the Child Care Regulatory Services. It is required for each child upon enrollment in a child care facility, ensuring that all health, emergency contact, and general information are accurately recorded and kept up-to-date. Parents or guardians are tasked with completing and regularly updating this form, which is then maintained by the child care facility. Click the button below to start filling out the DSS 2900 form and take the first step in securing a safe and caring environment for your child.

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Dss Form 2900 PDF Details

Ensuring the health and safety of children in child care facilities is a priority that requires thorough documentation and adherence to regulatory standards. Among the critical documents designed to uphold these standards is the DSS Form 2900, mandated by the South Carolina Department of Social Services. This form serves as a comprehensive record of a child's health information and a declaration of their readiness to participate in child care programs. It is an essential document, filled out by parents or guardians at the time of a child's enrollment into a facility. The form covers a wide range of information, including general data about the child's name, birth date, home address, and the names and contact information of parents or guardians. Furthermore, it outlines specific health details such as the child’s medical conditions, regular medications, and health care providers, including physicians and dental care professionals. Also included is vital information regarding emergency contact persons authorized to make decisions if parents or guardians cannot be reached. The form mandates an update whenever there are significant changes in the child's health or personal information, ensuring that the child care facility has the most current data on hand. By capturing detailed health information and emergency contacts, the DSS Form 2900 plays a crucial role in safeguarding children’s well-being while under the care of child care facilities.

Question	Answer
Form Name	Dss Form 2900
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	dss 2900, dss form child child care, south carolina form child care, dss form 2900

How to Fill Out DSS Form 2900

DSS Form 2900 at a glance

What it is: The South Carolina Department of Social Services Child Care Regulatory Services General Record and Statement of Child's Health for Admission to Child Care Facility.

Who signs: Parent or Guardian: Signature and Date. Director/Operator/Staff Designee: Signature and Date.

A filled-in DSS Form 2900 example: a parent enrolls a child

DSS Form 2900 example filled out, example: a parent enrolls a child — A parent completes DSS Form 2900 when enrolling a child. The child attends Monday to Friday and has one parent listed. The picture shows the form filled in, and none of its entries is real. Nick Name stays empty because the child has no nickname. The second Parent/Guardian's Full Name and its phone boxes stay empty because only one parent is listed. Other Phone stays empty because the parent has a home phone and a work phone. The drop-in hours stay empty because the child attends regularly. Sat and Sun stay empty because the child attends Monday to Friday. Breakfast and Lunch are ticked, so Meals are not offered stays empty and the other meal boxes stay empty. Please explain stays empty because nothing needs explaining. The second line of Additional Comments stays empty because one line is enough. Both Date boxes next to the signature lines stay empty because each signer dates the form when signing.

How to fill out DSS Form 2900, box by box

Name of Facility and its address

Enter the Name of Facility and the County.

Under Address, enter the Street Address, with no Post Office Boxes, and the City, State, Zip.

Child's Name and Child's Current Home Address

Under Child's Name, enter the Last, First, Middle Initial and Nick Name.

Enter the Date of Birth and the Enrollment Date.

Under Child's Current Home Address, enter the Street Address and the City, State, Zip.

Parent/Guardian's Full Name

Enter the Parent/Guardian's Full Name, then the Home Phone, Work Phone and Other Phone.

For a second Parent/Guardian, enter the Parent/Guardian's Full Name, then the Home Phone, Work Phone and Other Phone.

Person responsible if parent/guardian unavailable for emergency medical services

You must have two individuals who have the authority to obtain emergency medical treatment for the child.

For each of 1. and 2., the Person responsible if parent/guardian unavailable for emergency medical services, enter the Full Name, the Relationship, the Address (Street Address, City, State, Zip), the Telephone Number(s) and the Family Code Word(s).

Hours of care and days

Under My Child will regularly attend this facility, enter FROM and TO with am/pm.

If Child is a drop-in, indicate hours of care: FROM and TO with am/pm.

Check all days Child will regularly attend this facility: Mon, Tue, Wed, Thurs, Fri, Sat, Sun.

Meals

Check all meals Child will receive daily: Meals are not offered, Breakfast, Morning Snack, Lunch, Afternoon Snack, Dinner, Evening Snack.

Family Physician or Health Resource and Emergency Care Provider

Under Family Physician or Health Resource, enter the Name, Street Address, City, State, Zip and Telephone.

Under Emergency Care Provider, enter the Emergency Facility Name, Street Address, City, State, Zip and Telephone.

Dental Care Provider and Health Insurance Provider

Under Dental Care Provider, enter the Name, Street Address, City, State, Zip and Telephone.

Enter the Health Insurance Provider.

Certificate of Immunization, health conditions and comments

For Certificate of Immunization, mark Yes, No or N/A, and enter Please explain.

Enter the health conditions such as allergies, asthma, diabetes, epilepsy, etc., and/or the medications the child takes on a regular basis.

Enter Additional Comments.

I certify that to the best of my knowledge

"I certify that to the best of my knowledge Child's Name is in good mental and physical health and able to participate in the child care program at Name of Child Care Facility."

Parent or Guardian: Signature and Date.

Director/Operator/Staff Designee: Signature and Date.

More rules for DSS Form 2900

GENERAL INFORMATION: to be completed by Parent or Guardian.

Mark Yes or No for: Is Child currently enrolled in school? (5K up to 6 years old).

HEALTH INFORMATION: to be completed by Parent or Guardian.

DSS Form 2900 (MAR 10): the Edition of OCT 07 is obsolete.

Common questions about DSS Form 2900

What is a DSS 2900 form?

The South Carolina Department of Social Services Child Care Regulatory Services General Record and Statement of Child's Health for Admission to Child Care Facility. This form is to be completed for each child at the time of enrollment in the child care facility, updated as needed when changes occur, and maintained on file at the facility.

Sources

[1] DSS Form 2900 (MAR 10), General Record and Statement of Child's Health for Admission to Child Care Facility, South Carolina Department of Social Services (the Official source link on this page).