DSS Form 2902: Application to Operate a Child Care Facility

You are prohibited by law from applying for a child care license or registration if you have been convicted of a crime listed in the South Carolina Code of Laws, Chapter 3 of Title 16 (Offenses Against the Person), the crime of contributing to the delinquency of a minor (contained in Section 16-17-490), the felonies classified in Section 16-1-10(A), the offenses enumerated in Section 16-1-10(D), or a criminal offense similar in nature to those crimes in other jurisdictions or under federal law.

A person who has been convicted of a crime enumerated in Subsection A of South Carolina Code Section 63-13-40 who applies for employment with, is employed by, or seeks to provide caregiver services in, or is a caregiver at such a facility is guilty of a misdemeanor and upon conviction must be fined not more than five thousand dollars or imprisoned not more than one year, or both.

Write your Initial and the Date on the line "I have read the information".

Check one: NEW, RENEWAL, NEW DIRECTOR, CHANGE OF FACILITY NAME or CHANGE OF OPERATING HOURS.

Enter the Name of Facility, the Name of Director(s), the Facility FEIN No. OR Owner's Social Security Number and the Name of Owner(s) or LLC members.

Enter the Telephone (include area code), the Facility Street Address (include city, state, zip), Fax (include area code), Mailing Address (if different; include city, state, zip), Cell Phone (include area code), Billing Address (if different; include city, state, zip) and E-Mail.

Under Days of Operation, check all that apply: M, Tu, W, Th, F, Sa, Su.

Fill in the Hours of Operation: _______ AM/PM till _______ AM/PM.

Mark Yes or No for Overnight Hours (operating between 1AM - 5AM).

Under Type of Facility Applying For, a Child Care Center is for 13 or more children: check Licensed Faith-Based Sponsored Facility, Approved Publicly Funded Center/Head Start, Licensed Private For-Profit Center, Licensed Private Non-Profit Center, Registered Faith-Based Sponsored Facility, Approved Publicly Funded Center/School District or Approved Publicly Funded Center Other.

A Group Child Care Home is for 7 - 12 children and a Family Child Care Home for no more than 6 children: check Licensed Group Child Care Home, Licensed Family Child Care Home or Registered Family Child Care Home.

Enter the Name of Facility and the Permit Number.

Check the method by which meals will be provided: Prepared at Kitchen in Facility, Prepared at a DHEC approved Kitchen, Provided by Parents, Prepared by a Food Service Company, Provided by Local School System or Provide Snack Only.

RENEWALS ONLY: mark Yes or No for Have your facility policies been updated or revised since your last renewal?

If your facility policies are available online, list the website address.

Mark Yes or No to Do you participate in the ABC Quality? If yes, check which ABC Level.

Mark Yes or No to Do you participate in the USDA Child Adult Care Food Program?

Write your Initial and the Date to certify that during the past seven years the applicant has not been disqualified from participating in any other publicly funded program for violating program requirements.

"Publicly-funded" programs are any program or grant funded by federal, state or local government.

Select One: certify that you have liability insurance on your child care facility, or certify that you have a written notice stating you do not have liability insurance that is signed by parents and kept on file, as long as the child is enrolled; then write your Initial and the Date.

Sign the Signature line, stating that all information is true to the best of your knowledge, and write the Date.

Common mistake: A handwritten signature is required on this form. An electronic or font signature will not be accepted and will delay processing.

Sign and date the second Signature line after "THE UNDERSIGNED CERTIFIED TO".

A child care facility cannot begin to operate until a license, approval or registration has been issued to that facility by the Department of Social Services (Sec. 63-13-10. et seq., Code of Laws of South Carolina, as amended).

Comply with the other regulations applicable to this child care facility, which include but are not limited to regulations regarding staff: child ratios and supervision of children, beginning with the first day that care is provided to children.

It is your responsibility to secure current criminal history background records as well as Central Registry/Sex Offender background checks for all facility staff prior to their employment.

Criminal history background checks need to be repeated every 5 years and Central Registry/Sex Offender checks must be repeated at every renewal.

It is your responsibility to report to the Department any changes which affect the status of your child care facility license, approval or registration.