Daycare Form Check In.pdf

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Daycare check in sheet
Child Care Check-in Sheet
Child Care Check-in Sheet
_______________________ __________
Child’s Name Date
_______________________ __________
Child’s Name Date
Drop off time: ________ Pick up time : ________
Drop off time: ________ Pick up time : ________
Last feeding was: __________________ Time : ________
Last feeding was: __________________ Time : ________
Last bottle was: __________________ Time : ________
Last bottle was: __________________ Time : ________
Last diaper changed at what t ime? ________
Last diaper changed at what t ime? ________
In the past 12 hours have you noted any of the following?
In the past 12 hours have you noted any of the following?
Yes No Notes
Yes No Notes
Fever ____ ____ _______________
Fever ____ ____ _______________
Diaper rash ____ ____ _______________
Diaper rash ____ ____ _______________
Other rash ____ ____ _______________
Other rash ____ ____ _______________
Persistent diarrhea ____ ____ _______________
Persistent diarrhea ____ ____ _______________
Reflux or vomiting ____ ____ _______________
Reflux or vomiting ____ ____ _______________
Medications, treatments, dosage and times if applicable
Medications, treatments, dosage and times if applicable
Is there anything you would like for us to know about or watch for?
Is there anything you would like for us to know about or watch for?
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