infant Info

ENROLLMENT WORKSHEET

Ohio Department of Job and Family Services

This information should be completed by the parents prior to the child’s first day. This information should be updated periodically as the infant’s needs change.

Download Infant Info Form

Fill your details

Child's Name

Nickname

Child's Date of Birth

Siblings

What are you feeding your infant? (Check all that apply)

Formula (include brand) Breast milk

Formula preparation (if center/provider is to prepare.)

Amount for each feeding

Frequency of feedings

My infant likes a bottle warmed: (Check one)

Room temp Warm Very warm/NOT HOT

Juice (type, amount, when?)

Does child use a cup yet?

No Yes

Solid foods (baby food, brand, types, amounts, frequency)

*you must have written permission from your child's physician if your child is under 4 months and given solid foods.

Are foods served room temperature or warmed?

Table food (types, amounts, frequency, special instructions)

Security items (pacifier, blankies, etc.)

Nap schedule

Hints for getting baby to sleep

Sleeping Position

Back Side* Tummy*

*You must secure a sleep position waiver from your child's physician if your baby is to sleep on their tummy or side. Please contact the center/provider for a JFS 01235.

Special Precautions

Any additional information about your child that would be helpful or you would like staff to know.

Parent Signature

Primary Caregiver Signature

Date

Date form last updated

The Children’s Place Learning Academy provides a smaller safe and secure environment for children during the most important years of their development.

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