Child’s Name:  ___________________________________

INFANT & TODDLER SUPPLY CHECKLIST

_____ DIAPERS 

_____ CHANGE OF CLOTHES

_____ WIPES  

______ PACIFIER


_____ TOPICAL OINTMENTS

_____ TEETHING GEL

_____ POWDER


NUTRITION & RELATED PRODUCTS

_____ FORMULA

_____ BOTTLES

_____ BABY FOOD:

CEREAL, FRUIT, VEGETABLES, PROTEIN:  BEEF, CHICKEN, ETC.

PLEASE INCLUDE A VARIETY IN YOUR CHILD’S DIET!

Statement of Permissions

I am giving my permission for the center to dispense the following items to my child:

_____ Wipes:  __________________________________________fill in product name

_____ Topical Cream:  ___________________________________fill in product name

__________________________________                                                                       _____/_____/_____

                   Parent Signature                                                                                                               Date