NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
LDSS-4443 (5/2014) FRONT
Month:
CHILD CARE ATTENDANCE SHEET
Year:
Program Name:
INSTRUCTIONS: Actual times in and out must be recorded in the spaces below. Check box if child is absent. Daily health care check must be checked after conducted. If there are health care concerns, notes
must be recorded elsewhere. CACFP participants may use this form to record each child’s food participation for each day.
MONDAY
CHILD’S NAME
First Name
Last Name
DOB:
/
/
FOOD*
B
AM
L
PM
S
EV
Date
/
TUESDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
MONDAY
CHILD’S NAME
First Name
Last Name
DOB:
/
/
FOOD*
B
AM
L
PM
S
EV
Date
/
First Name
Last Name
DOB:
/
/
FOOD*
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
First Name
Last Name
DOB:
/
/
FOOD*
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
CHILD’S NAME
IN
OUT
Absent
Health check
First Name
Last Name
DOB:
/
/
B
AM
L
PM
S
EV
Date
IN
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
/
B
AM
L
PM
S
EV
/
IN
OUT
Absent
Health check
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
IN
/
THURSDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
WEDNESDAY
FOOD*
/
OUT
Absent
Health check
*B=Breakfast AM= AM snack L= Lunch PM= PM snack S= Supper EV= Night snack
B
AM
L
PM
S
EV
Date
IN
/
FRIDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
/
B
AM
L
PM
S
EV
/
IN
OUT
Absent
Health check
OUT
Absent
Health check
Page totals B
B
AM
L
PM
S
EV
AM
Date
IN
/
B
AM
L
PM
S
EV
IN
OUT
Absent
Health check
Date
/
IN
OUT
Absent
Health check
Date
/
OUT
Absent
Health check
Date
/
/
OUT
Absent
Health check
OUT
PM
B
AM
L
PM
S
EV
S
Date
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
OUT
Absent
Health check
EV
B
AM
L
PM
S
EV
Food
Totals
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
FRIDAY
FOOD*
Absent
Health check
L
Food
Totals
/
FRIDAY
FOOD*
/
THURSDAY
FOOD*
/
FRIDAY
FOOD*
/
IN
Date
Date
FRIDAY
FOOD*
/
THURSDAY
FOOD*
/
IN
/
THURSDAY
FOOD*
/
IN
Date
THURSDAY
FOOD*
/
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
WEDNESDAY
FOOD*
/
IN
Date
Date
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
MONDAY
FOOD*
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
MONDAY
CHILD’S NAME
/
TUESDAY
FOOD*
/
MONDAY
CHILD’S NAME
Date
B
AM
L
PM
S
EV
LDSS-4443 (5/2014) REVERSE
MONDAY
CHILD’S NAME
First Name
Last Name
DOB:
/
/
FOOD*
B
AM
L
PM
S
EV
Date
/
TUESDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
MONDAY
CHILD’S NAME
First Name
Last Name
DOB:
/
/
FOOD*
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
CHILD’S NAME
First Name
Last Name
DOB:
/
/
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
IN
OUT
Absent
Health check
CHILD’S NAME
First Name
Last Name
DOB:
/
/
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
First Name
Last Name
DOB:
/
/
FOOD*
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
IN
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
/
B
AM
L
PM
S
EV
IN
OUT
Absent
Health check
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
IN
/
THURSDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
B
AM
L
PM
S
EV
WEDNESDAY
FOOD*
/
OUT
Absent
Health check
*B=Breakfast AM= AM snack L= Lunch PM= PM snack S= Supper EV= Night snack
B
AM
L
PM
S
EV
Date
IN
/
FRIDAY
FOOD*
/
IN
OUT
Absent
Health check
B
AM
L
PM
S
EV
Date
/
IN
OUT
Absent
Health check
Date
/
B
AM
L
PM
S
EV
OUT
Absent
Health check
/
B
AM
L
PM
S
EV
IN
OUT
Absent
Health check
OUT
Absent
Health check
Page totals B
B
AM
L
PM
S
EV
AM
Date
IN
/
B
AM
L
PM
S
EV
IN
OUT
Absent
Health check
Date
/
IN
OUT
Absent
Health check
Date
/
OUT
Absent
Health check
Date
/
OUT
Absent
Health check
OUT
PM
B
AM
L
PM
S
EV
S
Date
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
OUT
Absent
Health check
EV
B
AM
L
PM
S
EV
Food
Totals
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
IN
B
AM
L
PM
S
EV
Food
Totals
/
FRIDAY
FOOD*
/
Absent
Health check
L
Food
Totals
/
FRIDAY
FOOD*
/
THURSDAY
FOOD*
/
/
FRIDAY
FOOD*
/
IN
Date
Date
FRIDAY
FOOD*
/
THURSDAY
FOOD*
/
IN
/
THURSDAY
FOOD*
/
IN
Date
THURSDAY
FOOD*
/
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
/
WEDNESDAY
FOOD*
/
IN
Date
Date
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
MONDAY
CHILD’S NAME
WEDNESDAY
FOOD*
/
TUESDAY
FOOD*
/
MONDAY
FOOD*
/
TUESDAY
FOOD*
/
MONDAY
FOOD*
Date
B
AM
L
PM
S
EV