Yes No Yes No

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Yes No. If yes, have medication forms been completed? Yes No. Additional information for the caregivers to know about your child's daily requirements or routine ...

Daily Care Form — Pretoddler Date: _____________________________ Child’s Name: ___________________________________

Drop Off Time: _____________________

Parent’s Name: _________________________________

Pick Up Time: ______________________

INFORMATION FROM HOME (to be filled out by parent) What time did your child wake up today? ____________________ Does your child usually nap?



Has your child had breakfast/lunch? Is your child on medication?

If yes, for how long? ____________________________




No If yes, which medications and why? ________________

__________________________________________________________________________________ Will the center administer the medication?


No Yes

If yes, have medication forms been completed?


Additional information for the caregivers to know about your child’s daily requirements or routine: __________________________________________________________________________________ __________________________________________________________________________________ DAILY HEALTH CONCERNS (to be filled out by parent) Allergies: __________________

Teething: ________________

Rashes: ___________________

Bumps, bruises, or marks: _____________________________________________________________ Additional information for the caregivers: _________________________________________________ __________________________________________________________________________________ INFORMATION ABOUT YOUR CHILD’S DAY (to be filled out by Navy CYP) For breakfast I ate:




Comment: _____________________________

For lunch I ate:




Comment: _____________________________

During quiet time I:


Rested quietly

Didn’t feel like resting

Diaper Changes W = Wet Time


D = Dry Time

B = Bowel Movement Type

Your child enjoyed the following activities: _________________________________________________ __________________________________________________________________________________ Overall, your child’s day was: ___________________________________________________________ For your child’s next visit, be sure to bring: ________________________________________________ Thank you! We look forward to seeing you again soon!

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