MSI Nutrition Agreement Form

							Nutrition Agreement                                                                   Form 2 of 6


Child’s Name: __________________________________________________

       In accordance with the Broward County Child Care Ordinance/Family Child Care Ordinance, the
       Mailman Segal Institute’s Early Learning Programs work cooperatively to assure that children are
       provided with nutritious snacks and meals when not supplied by the program.

       We encourage parent participation on a regular basis. Approximately once every 4-6 weeks,
       parents are encouraged to volunteer in their child’s classroom. On those days, the volunteer parent
       provides a healthy, nutritious snack for the entire class. Please sign this form and return it to the
       business office located on the second floor of building 100.

               The parent/caregiver agrees to provide a daily breakfast and lunch for their child, and on
                rotating basis a healthy mid-morning snack for the entire class
               MSI agrees to provide a healthy, nutritious snack in the mid-afternoon for all children
                participating in our extended day program

                           Please Note that Only Healthy, Nutritious Snacks Will Be Served

My signature indicates that I have read and agree with the proceeding:

Parent Signature:        _________________________                   Date: _____________

Director’s Signature:      __________________________________________

                                        (Please Detach and Keep For Your Records)


                           Smart School Snacks – Grocery List Suggestions
       Please provide one or two items from each category. Remember, we are a peanut free zone!

     Fruits               or    Vegetables      and                  Grains         +        Protein
     Berries                    Cucumber Rounds                      Pretzels                Cream Cheese
     Oranges                    Celery                               Breads                  Sunbutter
     Bananas                    Avocado                              Crackers                Cheese
     Grapes (cut)               Sweet Pepper                         Cereal                  Milk
     Apples/Pears               Salsa                                Tortilla Shells/Chips   Bean Dip
     Melon                      Cherry Tomatoes                      Rice Cakes              Tofu
     Plums                      Cooked Carrots/Broccoli                                      Yogurt
     (Please pit all fruits)


                               Choking Hazards for Children Under 4 Years of Age
Hot dogs and similar foods served whole                    Nuts, seeds, peanuts
Popcorn                                                    Ice cubes
Raisins and other dried fruit                              Large chunks of meat or cheese




              Nova Southeastern University • Mailman Segal Institute for Early Childhood Studies
        The Jim & Jan Moran Family Center Village • 3301 College Avenue • Fort Lauderdale, FL 33314