Infant Needs & Services Plan

For infants ages 0–2 years · California Community Care Licensing

Please note: This plan is required for every infant (ages 0–2) prior to their first day, and is reviewed and updated with a parent/guardian at least every 3 months, or whenever your child's needs change. You may fill it in below and print it, or print it blank and complete it by hand. Please sign and bring it with you.

1 Child Information

Child's full name

Date of birth

Age at admission

Parent / guardian name

Daytime phone

Primary language spoken at home

Date plan completed

2 Feeding

Feeding method

Breast milk Formula Both Table / solid foods

Type / brand of formula or milk

Amount per feeding

Feeding schedule & times (or "on demand")

Solid foods introduced / dietary preferences

Food allergies or restrictions

Special feeding instructions (position, bottle warming, self-feeding, etc.)

3 Sleeping

Usual nap times

Number & length of naps

Sleep position (infants are placed on their back per state regulation)

Back (default) Other — physician's note attached

Sleep routine & soothing habits

Comfort items (pacifier, blanket, etc.)

4 Diapering & Toileting

Diaper brand

Diapering schedule

Creams, ointments or wipes to use (and any provided by parent)

Toilet-training status & approach (if applicable)

Diaper rash or skin sensitivities

5 Development & Activity

Current developmental level (rolling, sitting, crawling, pulling up, walking, etc.)

Favorite activities, toys & ways of playing

Communication & soothing cues (how your child shows hunger, tiredness, discomfort)

6 Health & Medical

Physician's name

Physician's phone

Known allergies (food, medication, environmental)

Current medications & administration instructions

Special health conditions or needs

Immunizations up to date?

Yes — records attached No / in progress

7 Additional Instructions & Family Preferences

Cultural, religious or family preferences for your child's care

Anything else our teachers should know

8 Agreement & Signatures

This plan was developed jointly by the parent/guardian and Lotus Montessori staff, and will be reviewed together at least every three months. We agree to the care described above.

Parent / Guardian signature

Date

Lotus Montessori staff signature

Date

Review dates: ____________ · ____________ · ____________ · ____________ (reviewed at least every 3 months)