Obligation To Serve Infants In The Cacfp printable pdf download

Obligation To Serve Infants In The Cacfp

Obligation to Serve Infants in the CACFP

IDOE/CACFP

revised 06/02

Dear Parents/Guardians:

This center/home/ministry participates in the Child and Adult Care Food Program (CACFP) and receives USDA

reimbursement for serving nutritious meals to infants and children. Participation in this program requires caregivers to

follow specific meal patterns according to the age of the child being fed.

Policy requires a center/home/ministry participating in the CACFP to offer formula and meals to infants who are in care

during meal service times. Parents/guardians, however, may decline what is offered, and supply the infant’s meals

instead.

Please complete the following information:

Name of Provider/Child Care Center/Ministry:________________________________________

Name of Infant_________________________________________________________________

Birth date _____________________________________________________________________

Type(s) of formula offered:_______________________________________________________

I accept the type(s) of formula offered by my provider/childcare center/ministry.

I decline the type(s) of formula offered by my provider/childcare center/ministry.

I will provide ______________________formula/breast milk for my infant.

I accept the meals and snacks offered by my provider/childcare center/ministry.

I decline the meals and snacks offered by my provider/childcare center/ministry.

I will provide meals and snacks for my infant.

____________________________________

________________________

SIGNATURE OF PARENT/GUARDIAN

DATE

1. This form must be kept on file for each infant enrolled for childcare.

2. As situations change, such as a medical authority changing the infant’s formula, a new form should be completed.

3. This form must be kept current and accurate for each infant enrolled for childcare until the infant reaches one year of age or is

no longer on infant formula.

4. If the parent/guardian declines the formula and the provider provides meal and/or snack components, the meal may be

claimed for reimbursement.

5. If the parent/guardian declines infant meals/snacks, meals and snacks may NOT be claimed for reimbursement.

Obligation To Serve Infants In The Cacfp