TX HHS Form 2935. Admission Information

Form 2935 is used in Texas child care facilities to collect essential information about a child before enrollment. Parents or guardians must complete this form and return it to the day care provider prior to the child’s first day. The completed form is kept on file at the child care operation as required by licensing standards.

Purpose of Form 2935

This form ensures that day care providers have all necessary personal, medical, and emergency information to protect the health and safety of each enrolled child. It also documents parental permissions for transportation and field trips.

Main Sections of the Form

General Information

This section identifies the child care operation and collects core information about the child and parents or guardians. It includes:

• Operation’s name and director’s name
• Child’s full name, date of birth, and home address
• Living arrangements (both parents, mom, dad, or guardian)
• Admission and withdrawal dates
• Parent/guardian names and addresses
• Contact phone numbers for parents and guardians
• Custody documentation status

Emergency Contact Information

Parents provide the name, relationship, phone number, and address of an emergency contact who may be reached when parents or guardians are unavailable.

Authorized Release Persons

This section lists individuals authorized to pick up the child from the facility. Parents must provide names and phone numbers. The child care provider verifies identity before releasing the child.

Consent Information

Parents or guardians indicate permissions for:

• Transportation for emergency care
• Transportation on field trips
• Transportation to and from home or school

This section also includes parental consent for the child’s participation in field trips, with space for additional comments.

Who Uses Form 2935

• Licensed child care centers
• Licensed child care homes
• Before-school and after-school programs
• Preschool programs and early childhood facilities

Why Form 2935 Is Important

• Ensures the provider has accurate emergency and contact information
• Documents legal permissions for release and transportation
• Helps maintain safety and compliance with Texas child care regulations
• Provides essential information to support the child’s daily care

Key Form Details

• Form Number: 2935
• Title: Admission Information
• Issued by: Texas Health and Human Services
• State: Texas
• Revision Date: January 2025