Infant Care Sheet Instructions
To be filled out monthly by parents of infants
Infant's name:
*
First Name
Last Name
Infant DOB:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Specific type of formula? RCLC provided or parent provided?
*
Warmed?
*
Yes
No
How many ounces and how often?
*
Juice?
*
Yes
No
Diet Information:
Infant Cereal?
*
Meat, Vegetables, Fruit?
*
What kind? Baby food? What type? Any from our published menu?
Any Allergies or Dietary Restrictions? Allergy symptoms produced?
*
Ointment or powders you will provide; how often do you want these applied?
*
Pacifier?
*
Yes
No
Soap?
*
Yes
No
Additional helpful information:
*
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: