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I tested out on the EDU 119 on DC DEE module last year
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Infant/Toddler Info Sheet By providing complete information on this form, you will help your child’s teachers to know and care for your child and create a positive experience while s/he is in our care. Licensing requires us to update information every three months for children under 2. Thank you! Child’s Name_ __________________________________________ Birthdate ____________ Room ____________ Parent’s/Guardian’s Name_______________________________________________________________________ Parent’s/Guardian’s Name_______________________________________________________________________ EATING Current feeding schedule ________________________ Length of time on this schedule _________________ Types of foods: breast milk ,formula milk (circle all that apply) _______________ strained, junior table How has child been fed: held in lap high chair or at table Child feeds self: no or yes: hands, spoon, or fork How does your child take milk/liquids: nurse bottle sippy cup, open cup If your child nurses, have they had a bottle: no or yes If yes, how often ___________________ Special feeding concerns : no or yes (describe)
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Can your child have filtered tap water: yes or no If not, you will need to provide bottled water. Food allergies: no or yes (describe)____________________________________________________
__ Does your child have any allergies other than to foods : no or yes (describe allergy and symptoms)
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__ NAPPING/SLEEP Does your child take a nap: yes or no How do you nap your child at home:_______________________________________________________________
________ What is their normal length of sleep:_______________________________________________________________ Indicate times:________________________________________________________________________________ _ What objects do they like to sleep with (blanket, soft toy): (for over 1 year only) ____________________________ Is your child a light sleeper, heavy sleeper, restless sleeper, or falls asleep easily Mood upon awakening: _________________________________________________________________________ Does your child use a pacifier for nap: no or yes If yes, brand________________ For children 1 year or younger: What is position while napping: back (recommended for children under 1 year side, stomach (neither recommended) circle all that apply , we need a signed statement from the doctor indicating they recommend the child to be put to sleep on their stomach or side and the parent must initial and date, indicating that they understand that one of the most important things they can do to help reduce the risk of SIDS is to put their child to sleep on their back. Date___________________________ Parent/Guardian initial______________________ DIAPERING/POTTING Does your child use: Diapers: no or yes ( disposable cloth) Ointment: yes or no Diaper wipes: yes or no Does your child have a sensitivity to certain brands of diapers/wipes:_____________________________________ Is your child in the beginning stages of toilet learning: yes or no Which does your child use at home: potty chair, toilet or neither Is your child: trained for urine or trained for bowels Do they wear a diaper at nap only Parents must provide the daily needed supply of diapers/wipes and extra clothing for each child. LANGUAGE Family speaks what language: English Other If Other, specify:__________________________ Does your child understand English when spoken to:yes or no Child speaks in: vocalizations (babbles, combined vowel sounds) words, sentences, Age child began talking: ___________________________ PHYSICAL DEVELOPMENT Is your child able to (check all that apply): get into a sitting position independently or pull themselves up or crawl or walk holding on or walk without support run or do stairs FAMILY CONSTELLATION With whom does your child reside: (Please list everyone who lives with your child and their relationship to the child, and pets you might have.)
What are some of your child’s favorite activities, interests and toys:
Is your child used to playmates: yes or no Have they been in group child care before: yes or no Anything else you would like us to know? Please use an additional sheet, if necessary.
Licensing requires that information be updated every 3 months for children under 2 years of age. Please review and update, then date/initial in next available spot below. Date________/Initial________ Date__________/Initial________ Date__________/Initial______ Programs/infant/infant toddler info sheet Thank You Infant Teacher Mrs Ashley Quick