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When enrolling a child in a daycare facility in South Carolina, a vital document comes into play: the DSS 2900 form. This comprehensive record serves multiple purposes, ensuring that key details about the child's health and emergency contacts are readily available. Parents or guardians must fill out this form at the time of enrollment and keep it updated as changes occur. The document gathers important general information, including the child's name, date of birth, and home address, along with contact details for parents and guardians. Not only does it include sections for emergency contacts—individuals designated to make medical decisions if guardians are unavailable—but it also captures crucial health information like allergies, medications, and existing health conditions. The form outlines the child's expected attendance schedule, including the days of the week they will be at the facility and the meals they will receive. Additionally, it allows parents to provide details about their child’s healthcare providers, thus ensuring that caregivers are equipped with the necessary information to keep the child safe and healthy. Ultimately, the DSS 2900 form plays a pivotal role in maintaining a secure and supportive environment for children in care.

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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.

GENERAL INFORMATION: (to be completed by Parent or Guardian)

Name of Facility:

 

 

 

 

 

 

County:

 

Select County ...

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address – no Post Office Boxes

 

 

 

 

City, State, Zip

 

Child’s Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

First

Middle Initial

Nick Name

Date of Birth:

 

 

 

 

Enrollment Date:

 

 

 

 

 

Child’s Current Home Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

City, State, Zip

 

Parent/Guardian’s Full Name:

 

 

 

 

 

 

 

 

 

 

 

Home Phone:

 

 

 

 

 

Work Phone:

 

 

 

 

Other Phone:

 

 

Parent/Guardian’s Full Name:

 

 

 

 

 

 

 

 

 

 

 

Home Phone:

 

 

 

 

 

Work Phone:

 

 

 

 

Other Phone:

 

 

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

1. Person responsible if parent/guardian unavailable for emergency medical services:

 

 

Full Name

Relationship

Address:

 

 

 

 

 

 

Street Address

City, State, Zip

Telephone Number(s):

 

Family Code Word(s):

 

2. Person responsible if parent/guardian unavailable for emergency medical services:

 

 

 

 

Full Name

 

 

 

 

 

 

 

 

 

 

Relationship

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

City, State, Zip

 

Telephone Number(s):

 

 

 

 

 

 

 

 

 

 

Family Code Word(s):

 

 

Is Child currently enrolled in school? (5K up to 6 years old) „ Yes

„ No

 

 

 

 

 

My Child will regularly attend this facility

FROM

 

 

 

am/pm

TO

 

 

 

am/pm

 

If Child is a drop-in, indicate hours of care: FROM

 

 

 

am/pm

TO

 

 

 

am/pm

 

Check all days Child will regularly attend this facility:

„ Mon „ Tue

„ Wed

„ Thurs „ Fri „ Sat

„ Sun

Check all meals Child will receive daily:

„ Meals are not offered

„ Breakfast „ Morning Snack

„ Lunch

„ Afternoon Snack „ Dinner „ Evening Snack

 

 

 

 

 

 

 

 

 

HEALTH INFORMATION: (to be completed by Parent or Guardian)

 

 

 

 

 

 

 

 

 

Family Physician or Health Resource:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

City, State, Zip

 

 

 

 

 

 

 

Telephone

 

Emergency Care Provider:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emergency Facility Name

Street Address

City, State, Zip

Telephone

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

Dental Care Provider:

 

 

 

Name

 

 

 

 

Street Address

City, State, Zip

Telephone

Health Insurance Provider:

 

 

 

 

Certificate of Immunization:

„ Yes „ No „ N/A Please explain:

 

 

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

Additional Comments:

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

Signature:

 

Date:

 

 

Parent or Guardian

 

 

Signature:

 

Date:

 

 

Director/Operator/Staff Designee

 

 

DSS Form 2900 (MAR 10)

PAGE 2

Document Specifications

Fact Name Details
Purpose of Form The DSS 2900 form is designed to document a child's health and general information for enrollment in a child care facility.
Completing the Form It must be filled out during the child's enrollment and updated as necessary when changes occur.
Record Maintenance The form must be kept on file at the child care facility for reference and compliance.
Required Information Information required includes the child's name, date of birth, current address, and parent or guardian contact details.
Emergency Contacts Two individuals must be listed who can obtain emergency medical treatment for the child if the parent or guardian is unavailable.
Enrollment Details The form also collects information about the child's regular attendance, including days and hours of care.
Health Information Parents or guardians must provide information about the child's health, including any conditions and medications taken regularly.
Certification Parents or guardians must certify that the child is in good physical and mental health to participate in the child care program.
Governing Law The usage of DSS 2900 form follows the regulations set forth by the South Carolina Department of Social Services.

Steps to Filling Out Dss 2900

Completing the DSS 2900 form is an important step when enrolling your child in a childcare facility. This form collects essential information about your child’s health and emergency contacts. Be ready to provide accurate details about your child, health providers, and emergency contacts as you fill it out. Follow the steps below to ensure the form is completed correctly.

  1. Gather Necessary Information: Collect all relevant information, including your child’s full name, date of birth, and your contact details.
  2. Fill in General Information: Enter the name and address of the childcare facility, along with the county where it is located.
  3. Provide Child’s Details: Input your child’s last, first, and middle name, as well as any nicknames. Include the enrollment date and current home address.
  4. List Parent/Guardian Information: Include the names and phone numbers of at least two parents or guardians. Make sure to note their home, work, and other phone numbers.
  5. Emergency Contacts: List two individuals (other than parents) who can provide emergency medical treatment if necessary. Include their full names, relationships to the child, addresses, and telephone numbers.
  6. School Enrollment: Indicate whether your child is currently enrolled in school and when they will attend the facility. Provide the specific hours your child will be at the childcare facility or indicate if they will be a drop-in.
  7. Select Days of Attendance: Check all the days your child will regularly attend the facility.
  8. Select Meals: Specify which meals your child will receive at the facility, or note if meals are not offered.
  9. Fill in Health Information: Write down your family physician’s name and contact information, as well as details for any emergency care and dental care providers.
  10. Insurance and Immunization: Input your health insurance provider’s information and indicate if you have a certificate of immunization.
  11. Health Conditions: Describe any health conditions or medications your child takes regularly. Include any additional comments if necessary.
  12. Certification: Sign and date the form, certifying that all information is accurate to the best of your knowledge, and ensure the childcare staff also sign.

More About Dss 2900

What is the DSS 2900 form used for?

The DSS 2900 form is a health and general record statement required for each child upon their enrollment in a child care facility in South Carolina. It must be filled out by the child's parent or guardian. This document serves to provide essential information about the child's health status, emergency contacts, and details about the child care facility. It's important to keep the form updated, especially when there are changes in the child’s health or other relevant information.

Who is required to complete the DSS 2900 form?

The form must be completed by the parent or guardian of the child being enrolled in a child care facility. Parents or guardians should provide accurate and comprehensive information, as this record is critical for the child’s health and safety while in care.

What information is required in the DSS 2900 form?

Key information includes the child's name, date of birth, and address, along with the facility's name and location. Parents must also provide contact details for themselves and two designated individuals authorized to make medical decisions for the child if the parent or guardian is unavailable. Health information, such as any medical conditions or medications, along with details about the child's healthcare providers, is also required.

How often should the DSS 2900 form be updated?

This form should be updated whenever there are significant changes in a child's health, address, or emergency contact information. Regular updates ensure that the child care facility has the most current information, which is vital for providing appropriate care and responding to any emergencies.

What happens if the information on the DSS 2900 form is inaccurate?

Inaccurate information on the DSS 2900 form can lead to serious consequences, particularly in emergencies. If medical providers are misinformed about a child's health conditions or medication, it can negatively impact the child's care. Therefore, it is essential to ensure all data provided is correct and regularly reviewed for accuracy.

Is the DSS 2900 form mandatory for all children in child care facilities?

Yes, the DSS 2900 form is mandatory for every child enrolling in a child care facility in South Carolina. Compliance with this requirement ensures that the facility can manage and respond to the health needs of each child effectively, thereby promoting a safe and healthy environment for all children.

Common mistakes

  1. Neglecting to fill out all required fields: Each section of the DSS 2900 form must be completed. Leaving out vital information can lead to delays or issues with enrollment.

  2. Using a Post Office Box for the address: The form specifically requires a street address. Using a P.O. Box could result in a rejection of the application.

  3. Failing to provide emergency contact information: At least two individuals must be listed who can obtain emergency medical treatment for the child. Omitting this information compromises the safety plan.

  4. Inaccurate or incomplete health information: Parents must detail any health conditions or medications. Misrepresentation can affect the child's care and safety.

  5. Not updating the form as needed: The DSS 2900 should be updated when any changes occur in the child’s health or contact information. Failure to do so may lead to outdated or incorrect records.

  6. Overlooking necessary signatures: Both the parent or guardian and the child care facility director must sign the document. Missing signatures can render the form invalid.

  7. Choosing incorrect meal options: Parents should accurately check all meals their child will receive. Misrepresenting this can affect meal planning and dietary needs.

Documents used along the form

The DSS 2900 form is necessary for enrolling a child in a daycare facility in South Carolina. Along with this form, several other documents may also be required to ensure comprehensive information about the child and their needs is collected. Below is a list of other forms often utilized in conjunction with the DSS 2900.

  • Child's Immunization Record: This document provides proof of the child's vaccinations. It is crucial for ensuring that the child complies with health regulations, promoting a safe environment in the daycare.
  • Emergency Contact Form: This form lists individuals who can be reached in case of an emergency. It includes their contact information and relationship to the child, ensuring timely communication during urgent situations.
  • Enrollment Agreement: A legally binding document detailing the terms and conditions of enrollment at the child care facility. This agreement clarifies fees, policies, and the rights and responsibilities of both parties.
  • Health History Form: Parents complete this form to provide a comprehensive overview of the child’s medical history. This includes past illnesses, surgeries, and any ongoing medical issues that may affect care or activities.
  • Parent Authorization for Medication Administration: If a child needs medication while at the facility, this form grants permission for caregivers to administer the medication. It details instructions and any specific requirements.
  • Child Care Provider Agreements: This document outlines the policies and procedures of the daycare. Parents must review and agree to these terms to ensure mutual understanding and compliance.
  • Referral Information: Sometimes required if a child is transitioning from another facility or program. This form provides insight into the child's previous care environment and any special needs they may have.
  • Profile Information Sheet: This document gathers information about the child’s likes, dislikes, and behaviors. It helps caregivers tailor experiences for each child, supporting individual development and comfort.
  • Consent for Field Trips: This form gives permission for the child to participate in off-site activities organized by the daycare. It typically includes information about the trip details and safety measures in place.
  • Child Development Assessment: An optional but beneficial form, this allows for evaluation of the child's developmental milestones. It helps identify any areas that may require additional attention or support.

When combining these documents with the DSS 2900 form, the daycare can effectively assess the child’s health and readiness for care. Each form contributes to a comprehensive understanding of the child's needs, creating a safer and more supportive environment for all children enrolled.

Similar forms

The DSS 2900 form, designed for registering a child's health and general information for child care facilities, bears similarities to the Child Health Assessment Form. This document serves a comparable purpose by ensuring that child care providers have access to important health details about children in their care. The Child Health Assessment Form includes sections for documenting medical history, current vaccinations, and any existing health conditions. Like the DSS 2900, it requires signatures from parents or guardians to confirm that the information provided is accurate, thus promoting the health and safety of children in group settings.

Another document that mirrors the structure and purpose of the DSS 2900 is the Enrollment Application for Child Care Services. This application also collects essential information about a child, including their emergency contacts, allergies, and any specific needs they may have. Both documents emphasize the importance of having emergency contacts listed, ensuring that the facility can respond promptly to any incidents. Parents or guardians are required to fill out these forms, reinforcing their role in sharing vital details that support the child’s health and accommodation within the facility.

Similar to the DSS 2900 form, the School Health Record serves to keep track of important medical information that is necessary for enrollment in educational settings. This record includes details about a child’s immunization status, health assessments, and any ongoing treatments or conditions. Both forms are intended to foster effective communication between the care provider or school and the family, thus ensuring a child's well-being is prioritized. Furthermore, these records are essential in case of emergencies, as they provide immediate access to a child's health history.

Lastly, the Parent Authorization Form for Emergency Medical Treatment aligns closely with the DSS 2900 format. This document is specifically used to give permission for child care operators to seek emergency medical attention if required. Like the DSS 2900, it requires detailed contact information for emergency contacts and delineates the relationship of those contacts to the child. Both documents empower parents by ensuring they have provided necessary permissions, which can be life-saving in urgent situations. Understanding and completing these forms is crucial for establishing a secure environment for children as they engage in child care or school activities.

Dos and Don'ts

When filling out the DSS 2900 form, attention to detail is crucial. Here are five things to keep in mind:

  • Do: Provide accurate information about the child’s health and emergency contacts.
  • Do: Update the form promptly if there are any changes in the child's health or contact details.
  • Do: Ensure all sections are completed, especially those related to health and emergencies.
  • Do: Sign and date the form to confirm all information is true and current.
  • Do: Maintain a copy of the completed form for your records.
  • Don’t: Use abbreviations or incomplete information that could cause confusion.
  • Don’t: Leave any required fields blank, as this may delay the enrollment process.
  • Don’t: Forget to include two emergency contacts with up-to-date phone numbers.
  • Don’t: Use a P.O. Box for the child’s home address; provide a physical address instead.
  • Don’t: Ignore instructions regarding medical and health information; these are vital for your child's safety.

Misconceptions

Understanding the DSS 2900 form is crucial for parents and guardians enrolling their children in child care facilities. Unfortunately, several misconceptions can lead to confusion regarding its use and requirements. Here are four common misconceptions debunked:

  • The DSS 2900 form is optional. Many parents assume that completing this form is a choice. In reality, it is a mandatory document that must be filled out for each child at enrollment. Keeping the information updated is also essential to comply with regulations.
  • Only health information is needed on the form. While health details are an important part of the DSS 2900 form, the document also collects general information such as emergency contacts and the child's attendance schedule. Each section is crucial for ensuring the child's safety and well-being.
  • Once the form is completed, it doesn't need updates. Some parents think that after submitting the form, further updates aren't required. However, any changes in the child's health status, emergency contacts, or other relevant details must be promptly updated on the form to ensure accurate and current records.
  • The details are only for the child care facility's use. While the information on the DSS 2900 form supports the child care facility in providing care, it can also be critical for emergency services if needed. Thus, the accurate documentation carries weight beyond the facility itself.

By clearing up these misconceptions, parents can better navigate the enrollment process and ensure their child’s health and safety while attending child care facilities.

Key takeaways

  • Purpose of the form: The DSS 2900 form is necessary for enrolling a child in a child care facility in South Carolina. It ensures that the facility has essential health information about the child.
  • Completion responsibility: Parents or guardians must fill out this form. Accurate details help the facility provide appropriate care for the child.
  • Information required: The form asks for the child's name, date of birth, and current home address. Additionally, contact details for two responsible individuals for emergencies are needed.
  • Emergency contacts: Designate two people who can authorize medical treatment for the child if the parent or guardian is unavailable. Include their full names, relationship to the child, addresses, and phone numbers.
  • Attendance schedule: Specify the child’s regular attendance hours and days of the week. This information is vital for planning the facility's daily activities.
  • Health information: Parents must disclose any health conditions, allergies, or medications the child has. This supports the child’s wellbeing in a group setting.
  • Provider contacts: Include details for the child’s family physician, emergency care provider, and dental care provider, if applicable. This information aids in quick access to medical support if needed.
  • Immunization certification: Parents must indicate if the child has a certificate of immunization. A clear understanding of the child’s immunization status is important for public health.
  • Signature verification: Both the parent or guardian and the facility director/operator must sign and date the form, verifying that the information is accurate and complete.