Yes No Yes No
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?
Yes
No
Has your child had breakfast/lunch? Is your child on medication?
If yes, for how long? ____________________________
Yes
Yes
No
No If yes, which medications and why? ________________
__________________________________________________________________________________ Will the center administer the medication?
Yes
No Yes
If yes, have medication forms been completed?
No
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:
None
Some
All
Comment: _____________________________
For lunch I ate:
None
Some
All
Comment: _____________________________
During quiet time I:
Slept
Rested quietly
Didn’t feel like resting
Diaper Changes W = Wet Time
Type
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!
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?
Yes
No
Has your child had breakfast/lunch? Is your child on medication?
If yes, for how long? ____________________________
Yes
Yes
No
No If yes, which medications and why? ________________
__________________________________________________________________________________ Will the center administer the medication?
Yes
No Yes
If yes, have medication forms been completed?
No
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:
None
Some
All
Comment: _____________________________
For lunch I ate:
None
Some
All
Comment: _____________________________
During quiet time I:
Slept
Rested quietly
Didn’t feel like resting
Diaper Changes W = Wet Time
Type
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!
