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Barnhart, MO
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Home
Programs
Infants
Toddlers
Twos
Preschool
Pre-K
About Us
About Us
Careers
Why Choose Us
Location
Parent Corner
Contact Us
Infant and Toddler Feeding and Care Plan
THIS SECTION TO BE COMPLETED BY CHILD CARE FACILITY:
The formula provided by this child care facility is:
(Check a box)
(Required)
Yes
No
This child care facility is participating in the Child and Adult Care Food Program (CACFP). In order to claim meals for reimbursement, the center must provide infant cereal and other foods when the child is developmentally ready for them.
Instructions to Parents:
Please complete for child who is less than 24 months of age. Update information as needed. Use a new form or initial/date changes on this form.
CHILD'S NAME
(Required)
First
Last
DATE OF BIRTH
(Required)
Month
1
2
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1924
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DATE ENROLLED
(Required)
MM slash DD slash YYYY
PARENT/GUARDIAN'S EMAIL ADDRESS
Feeding Information
Type of Food
Breast Milk
Feeding Time
Kinds of Food
Amount of Food
Formula
Feeding Time
Kinds of Food
Amount of Food
Infant Food
Feeding Time
Kinds of Food
Amount of Food
Table Food
Feeding Time
Kinds of Food
Amount of Food
Who is preparing (mixing) the formula?
Parent
Caregiver
Check all that apply:
Does your child have any problems with feedings, such as choking or spitting up?
Yes
No
Explain:
(Required)
Does your child use a pacifier?
Yes
No
Note: Pacifiers, if used, cannot be hung around an infant's neck. Pacifier mechanisms or pacifiers that attach to infant clothing cannot be used with sleeping infants.
Infant Feeding Preference (under 12 months)
Mark your preference (check all that apply).
I will provide breast milk for my infant.
I will nurse my infant at the center at these times:
I request that the formula provided by the child care facility be served to my infant.
I will provide infant formula for my infant. Name of formula:
I request that the child care facility provide solid foods for my infant as she is ready for them, and after I have discussed it with child care facility staff. OR
I will provide solid foods for my infant.
Times:
(Required)
The facility's formula may be used to supplement feedings if necessary:
(Required)
Yes
No
If breast milk is unavailable for a feeding, the facility should:
(Required)
Name of formula:
(Required)
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal and, where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or if all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632- 9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint for or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program. intake@usda.gov. USDA is an equal opportunity provider and employer.
Home
Programs
Infants
Toddlers
Twos
Preschool
Pre-K
About Us
About Us
Careers
Why Choose Us
Location
Parent Corner
Contact Us
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Inquire Now
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