Preschool Health and Nutrition Information Form
Please complete this form to provide essential health and nutrition information for your child. The information will be used for classroom care and meal planning only.
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Does your child have any food allergies?
*
No
Yes (please specify below)
If yes, please list all food allergies
Does your child have any dietary restrictions?
Vegetarian
Vegan
Gluten-Free
Lactose Intolerant
Other
Are there any foods your child especially likes or dislikes?
Does your child have any medical conditions we should be aware of?
*
No
Yes (please specify below)
If yes, please describe the medical condition(s)
Emergency Contact Name and Phone Number
*
Primary Physician Name and Phone Number
Submit
Should be Empty: