Infant Feeding Form | Vine and Branches Childcare Center

Child's Name

Date

Name of regular formula:

Name of emergency formula:

Is Formula served: COLD or WARM

**Note we are only able to warm formula one time before we must dispose due to VDSS guidelines

Has your child ever been treated by a physician for allergies?

When and for how long?

Food Restrictions:

Allergies:

Reactions we need to look for in child related to allergies and food restrictions:

**Vine & Branches’ Staff will feed babies on demand, but appreciate your assistance with providing typical feeding patterns at home.

Food Type

How Often Child Typically Eats

Amount

Parent Signature

Date

Director Signature

Date