Your child care facility participates in the Child and Adult Care Food Program (CACFP). The CACFP adminstered by the State Department of Education (SDE) and is funded by the United States Department of Agriculture (USDA). The CACFP provides reimbursement for serving nutritious, well-balanced meals to day care children while in care.

To be completed by the parent or guardian only.
The information you provide will be treated confidentially and will be used only for CACFP purposes

I wish to enroll my child/children whose names and enrollment information are given in the CACFP. I understand my child/children will receive meals at no extra charge to me when they are in care during any of the scheduled meal services. I have received a copy of The Child and Adult Care Food Program information sheet which explains the goals of the CACFP. I understand the day care home cannot and will not discriminate for reasons of race, color, national orign, age, or disability.  

    SVDP USDA Child and Adult Care Food Program  Enrollment Form

    Hours in care

    Infant formula benifit form

    For children up to 12 months of age. 
    Your child care faclity follows the CACFP Meal Pattern for Infants shown below. The types and amounts of food vary accoring to the age and developmental readiness of your baby. As the parent/guardian, you have rights and benefits as described in this notificaton. USDA supports and encourages moms to continue breastfeeding when returning to work or school. For formula fed infants, your facility provides an USDA approved iron-fortified infant formula(s) to be offered to babies in care.
    0-5 month old 
    Breakfast                      4-6 oz formula or breast milk
    Lunch/Dinner             4-6 oz formula or breast milk
    Snack                          4-6 oz formula or breast milk

    6-12 months old    
    Breakfast/Lunch &   6-8 oz formula or breast milk and
    Dinner                       0-4 Tablespoons infant cereal, meat,                                                       fish, poultry, whole eggs, dry beans, or                                                    peas, or                                                                                                          0-2 oz cheese or
                                         0-4 oz (volume) cottage cheese or                                                           yogurt; and
                                         0-4 tablespoons vegetable and/or fruit   Snack                       2-4 oz formula or breast milk and
                                         0-1/2 slice bread or 0-2 crackers, or 0-4                                                 tablespoons infant cereal or ready to                                                       eat cereal; and
                                         0-4 tablespoons vegetable and/or fruit.
    This facility has not requested or required me to provide infant formula or food for my infant
    Although you are not required to provide the following information, your cooperation will help determine compliance with Federal Civil Right Laws. In no instance will this information, whether provided or declined, be used in considering your application. We are authorized to ask for this information under Title VI of the Civil Rights Act of 1964, Collection of this information is strictly for statistical reporting requirements.  Please check correct categories below:
    By emailing this enrollment, I certify the information supplied is correct and I am this child's Parent or Guardian.
This institution is an equal opportunity provider.