CABIN KIDS CHILDCARE
RECORD OF CHILDS INDIVIDUAL NEEDS
(For Children under the age of 5 years old)
Name of Child
First Name
Last Name
Health
Rows
YES
NO
Are Immunisations up to date
Any Allergies
Any Medical Problems
Other
Further information - Health
Food likes/dislikes and favourite foods
Food Allergies / Intolerances
Rows
YES
NO
Allergies
If allergy or intolerance indicated please provide details:
Nappy / Toilet
Rows
YES
NO
Child still wears nappies
Nappy for sleeping
Child uses the toilet with assistance
Child uses the toilet
Does your child require a morning / midday nap?
Does your child have a nap-time routine?
Childs daily routine
Name of Parent
Signature of Parent
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Submit
Should be Empty: