Child Weekly Diet Routine
Child's name:
Parent's name:
Mother's Status:
Working
Not Working
Address:
Telephone number:
Email:
Is your child in Kidzee:
Yes
No
Child's Age:
2
3
4
5
6
7
8
9
10
Yrs.
Child's Gender:
Boy
Girl
Child's Statistics:
Height
inches
cm
Weight
Kg
Eating Habits:
Completes all the food in plate
Completes only the favourite items
Tastes all the items & leaves the food incomplete
Does not eat at all
Food Choices:
Vegetarian
Vegetarian + Egg
Non-Vegetarian
1) Roti/Chapati/Puri/Paratha:
Yes
No
2) Rice:
Yes
No
3) Milk:
Yes
No
Milk If Yes:
Plain Milk
With Nutritional Supplements
4) Vegetables:
Yes
No
List of Vegetables taken in meals during a week:
List of Leafy Vegetables taken in meals during a week:
List of fruits taken in meals during a week:
Junk Food:
Yes
No
Please specify how often the child consumes junk food and the list of the food items:
Food allergies (Please Specify):
Child's pediatricians:
Name
City
Location
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(On Child Nutrition):
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