Childcare Information Form Let us know a little more information about your child so we can offer the best care possible. Parent/Guardian Name(Required) First Last Email 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)12 months – 23 months24 months – 4 yearsPlease list the date(s) your child will be hanging out with usChildcare HistoryWhich best describes your child (Choose one)(Required)Has been in other childcare facilitiesHas NOT been in a childcare facility but has spent time with other children with family or friendsOnly spent time with our immediate familyOtherIf "Other" please explain(Required)Eating patterns and preferencesChild'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 Select AllAllergies 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 PatternsNote: 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)Toilet trainedDiaper trainedIn the process of toilet trainingChild's Sleeping PatternsNote: Children in our facility will be placed on their back to sleep in the cribNap 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?