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Cat Herder 07:41 PM 07-08-2011
The provider shall secure from the parents infant formula and feeding plan for children under 1 year of age.


Child’s Name Child’s Birthday Date Plan Completed
_____________ ______________ ______________


What type of formula is used? ___________________________________________

Amount of formula to be given: ___________________________________________

Updated amounts of formula:
Date:___________
Date:___________
Date:____________

Instructions for the introduction of solid foods:


Food likes:


Food dislikes:


Does child take a pacifier? Yes  No If yes, when? _________________________________

Does your child have Allergies/Known Medical Conditions (Include any premixed formula)?  Yes  No
If yes, please list: ______________________________________________________________________

Your child will be placed on back to sleep per SIDS rules unless written doctor’s statement is provided.

CHILD’S SCHEDULE:

Breakfast_______
(approximate time) Type and approximate amount of food

Lunch _______
(approximate time) Type and approximate amount of food

Dinner _______
(approximate time) Type and approximate amount of food


Morning Nap ______ Afternoon Nap ________
(approximate time) (approximate time)

Infant feeding plan needs to be updated every three months, or as needed, in regards to adding new foods or other dietary changes with a new parent/guardian signature and date:


Parent/Guardian Signature____________ Date_____________
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