Fillable Cacfp Infant Meals - Parent Preference Letter Template printable pdf download

CACFP

INFANT MEALS – PARENT PREFERENCE LETTER

TO:

Parents and Guardians of Infants under one year of age

FROM:

Name of Center

or Provider

TOPIC:

Who will provide food for your infant’s meals?

Due to participation on the Child and Adult Care Food Program (CACFP), all children enrolled at this child care center or

family child care (FCC) home receive meals free of charge. The CACFP is a child nutrition program of the United States

Department of Agriculture. Child care centers and family child care homes are reimbursed a meal rate to help with the cost

of serving nutritious meals to enrolled children. These centers and FCC homes can be reimbursed daily for up to two meals

and one snack served to each enrolled child, including infants. Emergency Shelters can be reimbursed for up to three

meals. The meals must meet CACFP meal pattern requirements for children and infants.

To meet CACFP requirements, the center or FCC home is required to offer formula and other required infant food to all

enrolled infants. The iron fortified infant formula we will provide for infants until they turn one year of age is:

Center or provider to insert the

NAME OF FORMULA that they will provide

A parent or guardian may decline the formula offered by the center or home and supply the infant’s formula themselves.

However, when an infant turns one year of age, the center or FCC home will begin to provide milk and the other required

food items to meet the meal pattern requirements for toddler age children.

To assist us in your infant formula and food preferences, please complete preferences below by checking one item each in

the formula and solid food section.

PARENT OR GUARDIAN: PLEASE CHECK YOUR PREFERENCES FOR FORMULA AND FOOD

Formula or Breast Milk: (check one)



I want the center or FCC home provider to provide formula for my infant



Parent/Guardian: List Name of Formula You Will Provide

I will bring iron fortified infant formula for my infant



I will bring expressed breast milk for my infant



I will come to the center or FCC home to breast feed my infant

Solid Food: (check one)



I want the center or FCC home to provide solid food for my infant when he/she is developmentally ready for it



I will bring solid food for my infant when he/she is developmentally ready for it

*Note: If your feeding preferences change, the center or provider will ask you to complete a new form.

INFANT’S NAME:

INFANT’S BIRTHDATE:

PARENT/GUARDIAN

DATE:

SIGNATURE:

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA,

its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from

discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any

program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for

program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local)

where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the

Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the

USDA Program Discrimination Complaint

Form, (AD-3027) found online

at: , and at any USDA office, or write a letter addressed to USDA and provide in

the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your

completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400

Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email:

program.intake@usda.gov.

This institution is an equal opportunity provider.

Rev. 12/2015

Cacfp Infant Meals - Parent Preference Letter Template

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