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Reg. No. CK87/17906/23

Was the pregnancy normal? What was the baby’s weight at birth? Jaundice at birth? Any blood transfusions? Oxygen administered in an incubator? Did the baby undergo any operations?

Breast-fed or bottle-fed? If breast-fed, how long? What type of milk does your baby drink now? Does your baby eat solids? What type of appetite does your baby have?

Parent / Guardian Signature:

_________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

20 Jarra Street Sharonlea Tel/Fax 011-4621810

71 Ebberhout Street Sharonlea Tel/ Fax/011-7041030 kerri@sharonleachildcare.co.za rita@sharonleachildcare.co.za

P.O.Box 527 Olivedale 2158

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