LJMS Toddler Needs & Service Plan

Child’s First Name:

Child’s Last Name:

DOB:

PARENT / GUARDIAN:

Phone Number:

Relationship to the Child:

PARENT / GUARDIAN #2:

Phone Number:

Relationship to the Child:

Feeding Care Plan:

1. Could you please provide the child’s usual eating times for the following meals, along with details of what they typically eat?

Review #1 (Due on the 1st visit)

Meal

Time

Breakfast

Snack

Lunch

Snack

Dinner

Breakfast Time

Review #2 (Due on the 1st conference)

Meal

Time

Breakfast

Snack

Lunch

Snack

Dinner

Breakfast Time

Meal

Time

Breakfast

Breakfast Time

Snack

Time

Lunch

Lunch Time

Snack

Snack Time 1

Dinner

Dinner Time

2. Please list all known food allergies:

3. What are the signs of allergy reactions, if any?

4. What are the child’s food dislikes or eating challenges?

5. What are the child’s food likes or eating preferences?

7. Does the child self-feed, or does the child need assistance during meals?

8. Please list any special diet requests, concerns, or special instructions you would like us to follow regarding your child’s eating pattern.

Toileting and Potty Training Plan:

1. Is the Child potty trained?

Yes

If yes, at what age?

If no, the child is in DIAPERS or PULL-UPS

2. How often does your child go potty or gets their diaper changed?

3. What word does your child use for urination or bowel movement?

4. Is your child allergic/sensitive to any other substances (i.e. latex gloves, certain types of wipes, etc)? If so, please list:

5. Do you use wipes?

YES

Brand:

6. Do you regularly use any ointments or creams for rashes?

7. Please list any additional instructions for us specific to your child’s needs on toileting and potty training plan.

Other Information:

1. When your child needs to be comforted, which position does your child prefer to be held?

2. Does your child have a security object?

YES

If yes, what is it and what does he/she call it?

3. Please share any additional information about your child that would help us provide them with the possible care and support:

Cubbies:

Each child is assigned their own cubby. Please ensure that your child has a change of clothes, diapers, wipes, and, if necessary, rash cream available throughout the year. The teachers will notify you in advance when any of these items need to be replenished.

Thank you for completing this plan for your child. We will review it together on the day of your child's first visit to the classroom. This Infant/Toddler Needs and Service Plan will be updated quarterly, or as often as necessary to assure its accuracy. Please do not hesitate to speak with us at any time in regards to your child’s needs.

I acknowledge the cubby requirements

YES

Parent Initials

As the child’s authorized representative, I verify that I have participated in preparing this Infant/Toddler Needs and Service Plan for:

Review #1 (Due on the 1st visit)

Parent Signature:

Date:

Teacher Signature:

Date:

Director Signature:

Date:

Review # 2 (Due on the 1st conference)

Parent Signature:

Date:

Teacher Signature:

Date:

Director Signature:

Date:

Test

Test

LJMS Toddler Needs + Service Plan

Feeding Care Plan:

Review #1 (Due on the 1st visit)

Review #2 (Due on the 1st conference)

Toileting and Potty Training Plan:

Other Information:

Cubbies:

Review #1 (Due on the 1st visit)

Review # 2 (Due on the 1st conference)