Childcare Information Form

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Let us know a little more information about your child so we can offer the best care possible.

Parent/Guardian Name(Required)

First Last

Child's Name(Required)

First Last

Child's Birthdate (mm/dd/yyyy)(Required)

Child's age at time of visit(Required)

How old will your little one be when they’re hanging out with us?

Child's age grouping at time of visit(Required)

Please list the date(s) your child will be hanging out with us

Childcare History

Which best describes your child (Choose one)(Required)

If "Other" please explain(Required)

Eating patterns and preferences

Child's Eating Preferences (Select all that apply)(Required)

Breast Milk

Formula

Baby Food

Table food

How often does your child eat? (hours)(Required)

How much does your child eat at each meal?(Required)

Acceptable snacks are (Check all that apply):(Required)

Water

Graham crackers

Cheese

Goldfish

Apple sauce

Allergies and action plan(Required)

Please list any allergies we should be aware of, the severity and any known symptoms and describe actions we should complete in the event of an allergic reaction.

Child's Bathroom Patterns

Note: Label and supply enough disposable diapers/pull-ups & wipes for all children not toilet trained. Please also bring a change of clothes.

Which best describes your child? (Select one)(Required)

Child's Sleeping Patterns

Note: Children in our facility will be placed on their back to sleep in the crib

Nap Times(Required)

Home Time Zone(Required)

Please let us know any advice or suggestions you have to help your child relax. Type if "none" if not applicable.(Required)

Other Considerations. EX: If your child is fussy, how might we calm them? Or any other advice/suggestions you have. Type "none" if not applicable.(Required)

General Likes/Dislikes ("None" if not applicable)(Required)

Is there any other information you'd like us to know about your child?