Infant Feeding Form

Our curriculum is the Teaching Strategies GOLD curriculum; an authentic, ongoing observational system for assessing children from birth through kindergarten.

Infant Feeding Form

Child's Name

Date

FORMULA DETAILS

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

FOOD ALLERGIES AND RESTRICTIONS

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:

FEEDING INSTRUCTIONS

**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

Add Remove

SIGNATURES

Parent Signature

Clear

Date

Director Signature

Clear

Date

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