Form 2935 at a glance
What it is: Form 2935 (June 2026), Admission Information: use this form to collect all required information about a child enrolling in day care. The day care provider gives this form to the child's parent or guardian.
Where and when to file: The parent or guardian returns the form before the child's first day of enrollment.
A filled-in Form 2935 example: a parent enrolls a child in day care
How to fill out Form 2935, box by box
Section 1 - General Information
Under Section 1 - General Information, enter the Operation's Name, Director's Name, Child's Full Name and Child's Date of Birth.
Mark Child lives with: Both parents, Mom, Dad or Guardian.
Enter the Child's Home Street Address, City, State and ZIP Code, the Date of Admission and the Date of Withdrawal.
Parent or Guardian 1 and Parent or Guardian 2, phone numbers and Custody documents on file
Enter the Name of Parent or Guardian 1 and the Name of Parent or Guardian 2. Enter the Address of Parent or Guardian 1, if different from the child's, and the Address of Parent or Guardian 2, if different from the child's.
List phone numbers where parents or guardian may be reached while child is in care: Parent 1 Area Code and Phone No., Parent 2 Area Code and Phone No. and Guardian's Area Code and Phone No.
Mark Custody documents on file? Yes or No.
Name of Emergency Contact and the following persons
In case of an emergency, when the parent or guardian cannot be reached, call: enter the Name of Emergency Contact, Relationship, Area Code and Phone No., and Street Address, City, State and ZIP Code.
You authorize the child care operation to release your child to leave the child care operation only with the following persons: list name and phone number for each. Children will only be released to a parent or guardian or to a person designated by the parent or guardian after verification of ID.
Enter the Name and Area Code and Phone No.
Transportation and Field Trips
Transportation: check all that apply to give consent for your child to be transported and supervised by the operation's employees: For emergency care, On field trips, To and from home, To and from school.
Field Trips: mark either that you give consent for your child to participate in field trips or that you do not give consent for your child to participate in field trips. Enter Comments.
Water Activities
Water Activities: check all that apply to give consent for your child to participate in the following water activities: Water table play, Sprinkler play, Wading pools, Swimming pools, Aquatic playgrounds.
Mark Is your child a competent swimmer? Yes or No. If no, your child is required to wear a life jacket while in or near a swimming pool. A competent swimmer can enter and exit a pool safely on their own, tread water or float on their back for one minute, and swim 25 yards with no assistance.
Mark Does your child have any physical, health, behavioral or other condition that would put them at risk while swimming? Yes or No. If yes, your child is required to wear a life jacket while in or near a swimming pool.
Receipt of Written Operational Policies
Receipt of Written Operational Policies: check all that apply to acknowledge receipt of the facility's operational policies.
Meals and Days and Times in Care
Meals: check all that apply; you understand the following meals will be served to your child while in care: None, Breakfast, Morning snack, Lunch, Afternoon snack, Supper, Evening snack.
Days and Times in Care: enter A.M. and P.M. for Monday, Tuesday, Wednesday, Thursday, Friday, Saturday and Sunday, the days and times your child is normally in care.
Receipt of Parent's Rights
Receipt of Parent's Rights: you acknowledge you have received a written copy of your rights as a parent or guardian of a child enrolled at this facility. SIGN and enter the Date Signed.
Child's Special Care Needs
Child's Special Care Needs: check all that apply: Environmental allergies, Limitations or restrictions on child's activities, Food intolerances, Reasonable accommodations or modifications, Existing illness, Adaptive equipment, include instructions, Previous serious illness, Symptoms or indications of complications, Injuries and hospitalizations in the past 12 months, Medications prescribed for continuous long-term use, Other:
Explain any needs selected. Mark Does your child have diagnosed food allergies? Yes or No, and enter the Food Allergy Emergency Plan Submitted Date.
Enter the Date Signed after you SIGN.
Section 3 - Authorization For Emergency Medical Attention
Section 3 - Authorization For Emergency Medical Attention: in the event you cannot be reached to arrange for emergency medical care, you authorize the person in charge to take your child to the Name of Physician and the Name of Emergency Care Facility, each with Area Code and Phone No. and Street Address, City, State and ZIP Code.
You give consent for the facility to secure any and all necessary emergency medical care for your child; SIGN, then enter the Date Signed.
More rules for Form 2935
Section 7 - Admission Requirement: If your child does not attend pre-kindergarten or school away from the child care operation, one of the following must be presented when your child is admitted to the child care operation or within one week of admission. Health Care Professional's Statement: I have examined the above named child within the past year and find they are able to take part in the day care program. A signed and dated copy of a health care professional's statement is attached.
Medical diagnosis and treatment conflict with the tenets and practices of a recognized religious organization, which you adhere to or are a member of. You have attached a signed and dated affidavit stating this.
Your child has been examined within the past year by a health care professional and is able to participate in the day care program. Within 12 months of admission, you will obtain a health care professional's signed statement and submit it to the child care operation. If selected, enter the Health Care Professional Name and Street Address, City, State and ZIP Code.
Section 8 - Vaccine Information: the following vaccines require multiple doses over time. Provide the date your child received each dose.
Section 9 - Physician or Public Health Personnel Verification: Signature or stamp of a physician or public health personnel verifying immunization information.
Section 10 - Varicella for Chickenpox: Varicella, the vaccine for chickenpox, is not required if your child has had chickenpox disease. If your child has had chickenpox, complete the statement: My child had varicella disease, chickenpox, on or about (date) and does not need varicella vaccine.
Under Signatures, enter a Date Signed for each SIGN.
If your situation is different
Section 4 - Requirements for Exclusion from Compliance
Section 4 - Requirements for Exclusion from Compliance: check the box if you have attached a signed and dated affidavit stating that you decline immunizations for reason of conscience, including religious belief, on the form described by Health and Safety Code Section 161.0041 submitted no later than the 90th day after the affidavit is notarized.
Check the box if you have attached a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a church or religious denomination that you are an adherent or member of.
Common questions about Form 2935
Is there a deadline?
The parent or guardian returns the form before the child's first day of enrollment.
Where do I file it?
The parent or guardian completes the form. Return it to the day care provider, who keeps the form on file at the child care facility.
Sources
[1] Form 2935 (June 2026), Admission Information, Texas Health and Human Services Commission (the Official source link on this page).