DSS Form 2963 at a glance
What it is: This form is the South Carolina Department of Social Services Child Care Licensing current list of children of a child care facility.
A filled-in DSS Form 2963 example: a facility lists two children
How to fill out DSS Form 2963, box by box
Name of Facility, County, Physical Address and Date
Enter the Name of Facility and the County.
Enter the Physical Address (Street, City, State, Zip) and the Date.
Child's Name and Age
Enter the Child's Name and Age for each child.
Group children by age levels: Under Two, Two, Three, Four, Five, and "6 and above".
Days in Facility
Enter the Days in Facility (Ex. Mon., Wed., Fri.).
Arrival Time and Departure Time
Enter the Arrival Time and the Departure Time.
DSS Use Only
DSS Use Only: Immunization, DSS Form 2900, Child's General Rec., Medication Authorization, Discipline Policy Statement, Swim, Field Trips, Corporal Punishment, Emergency Medical Treatment, ID Verification.
More rules for DSS Form 2963
DSS Form 2963 (JUN 09). Edition of March 94 is obsolete.
Sources
[1] DSS Form 2963 (JUN 09), Child Care Facility Current List of Children, South Carolina Department of Social Services (the Official source link on this page).