Infant Feeding Preferences
Infant's Name
Infant's Date of Birth
-
Month
-
Day
Year
Date
Today's Date
-
Month
-
Day
Year
Date
Today's Date
-
Month
-
Day
Year
Date
Breast Milk and/or Formula Preference (choose all that apply)
Birth through 5 months
6-11 months
I will bring expressed breast milk for my infant.
I want the child care provider to provide the infant formula it offers for my infant.
I will bring the infant formula for my infant. Please list the kind of infant formula you will bring.
Preference regarding infant cereal and other foods
6-11 months
My child is developmentally ready for solid foods. I want the child care provider to provide the infant cereal and other foods for my infant.
My child is developmentally ready for solids. I will bring the infant cereal and/or other foods for my infant.
My child is NOT developmentally ready for solid foods. I will inform the provider when and designate the solid food(s) to be introduced to my infant at that time.
Parent's (or guardian's) Signature
Date of Signature
-
Month
-
Day
Year
Date
This form must be kept on file for each infant enrolled for child care.
This form must be kept current and accurate for each infant enrolled for child care until the infant reaches one year of age.
If the parent (or guardian) provides expressed breast milk and the child care provider feeds it to the child, and/or if the mother breast feeds her child on site, the meal may be claimed for reimbursement.
If the parent (or guardian) declines the formula and the child care provider provides meal and/or snack components, the meal may be claimed for reimbursement.
If the parent (or guardian) declines infant meals/snack, meals and snacks may NOT be claimed for reimbursement.
Preview PDF
Submit
Should be Empty: