Marin Day Schools Infant / Toddler Needs and Services Plan
Name:____________________________Birth date:_________________
School Schedule: Days__________________Hours:_________________
Teachers:__________________________________________________
Campus:___________________________Class:___________________
General temperament of your child:_____________________________
__________________________________________________________
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Your child enjoys:___________________________________________ __________________________________________________________
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Your child dislikes:__________________________________________
__________________________________________________________
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What is most important in the care of your child?___________________
__________________________________________________________
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Are there any specific needs of your child you would like met? _______
__________________________________________________________
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Security and Sleep Patterns
Usual wake time (am)_______________ Sleep time (pm)_______________
How many naps daily?_______________ How long?___________________
Does you child sleep through the night?_____If no, how many times up at
night?_____________________________________________________
What security items does your child use? (Pacifier, blanket, stuffed animal,
etc.)
__________________________________________________________
How does your child usually go to sleep?_____________________________
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Does your child usually cry? __________For how long?_________________
If your child wakes during nap, can s/he be comforted back to sleep?
_________
Do you go to your child immediately or wait a few minutes?_______________
Feeding Plan
Bottle or breast fed?__________Type of Formula/Milk__________________
How many ounces are typical for each feeding?________________________
How frequently does your child have a bottle?_________________________
What solid food does your child eat?_________________________________
How frequently does your child eat?________________________________
Does your child drink juice?______water?_______use a tippy cup?________
Favorite foods:_______________________________________________
Allergies or food sensitivities:_____________________________________
Diapering
Type of diapers used:________________Brand of disposable:____________
How frequently does your child need to be changed?_____________________
Type of wipes used:____________Plain water or soap solution:____________
Special cream, ointment, powders used:_____________________________
Allergic reactions/sensitivities:___________________________________
Any unusual bowel or bladder problems?_____________________________
__________________________________________________________
Toilet Training
Date started:______________Words used at home:____________________
Patterns, routines and methods:___________________________________
__________________________________________________________
Progress information:
Day time: Bladder________________ Bowel______________________
Night time: Bladder________________ Bowel______________________
Nap time: Bladder________________ Bowel______________________ Toilet or
potty chair?___________Training pants or pull ups?____________
Developmental History
Which of the following does your child currently do? You are welcome to add
any information?
Smiles________ Sits propped_________
Holds head up______ Sits independently_______
Holds head steady_______ Sits in a child size chair________
Rocks on all fours_______ Creeps around crib_________
Rolls over: Grasps objects with both hands______
Front to back_________ Holds items in one hand_________
Back to front_________ Follows objects with eyes________
Pulls self up_________ Makes requests__________
Crawls_________ Talks________
Climbs__________ Walks with assistance_________
Stands with assistance_______ Walks alone__________
Stands alone_________ Other_________________________
Does your child have any disabilities or health concerns? If yes, please
explain in detail (special routines that need to be followed, special
exercises, regular medication, special equipment,
etc.)________________________________
______________________________________________________________________________________________________________________________________________________________________________
Parent’s signature______________________ Date___________________
Caregiver’s signature____________________ Date___________________
Next update due: (issued quarterly)________________________________
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