CAROUSEL KIDS

INFANT INFORMATION
Childs Name: _____________________________________ Enrollment Date: ______________
Date of Birth: ____/____/____ Moms Name: ______________ Dads Name: ______________
Does your child take a bottle? __________ If yes, which kind of formula? _________________
Is the bottle warmed? __________ Does your child hold his/her own bottle? ______________
Does your child eat:
Strained Foods

______________

Formula

______________

Baby Foods

______________

Whole Milk

______________

Table Foods

______________

Other

______________

Does your child take a pacifier? __________ If yes, when? _____________________________

Does your child need a special blanket, or any special item from home? __________________
Food likes: ___________________________

Food Dislikes: ___________________________

Is your child allergic to any foods or smells, etc? ______________________________________

When changing, do you use powder, Desitin, Vaseline, A&D or any type of diaper rash
ointment? __________ If so, which kind? ____________________________________________
FORMULA/BREAST MILK
TIME

AMOUNT

FOOD
TYPE

TIME

AMOUNT

TYPE

Please understand that we can not feed every child dinner at night. Our evening is a little busy getting everyone ready to go home. We will
feed breakfasts, lunch, snack and bottles as needed.

Any special instructions: __________________________________________________________

________________________________________________________________________________

Signature: ________________________________________

Date: ______________________

Ms. Annie strives to give each child the best care. Thank you so much for taking the time to fill in the above
information, which helps make this possible!