LDSS-4443 (5/2014) FRONT	New York State

Office of Children and Family Services

CHILD CARE ATTENDANCE SHEET
Month:	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.

CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
*B=Breakfast AM= AM snack L= Lunch PM= PM snack S= Supper EV= Night snack	Page totals B AM L PM S EV

LDSS-4443 (5/2014) REVERSE

CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
CHILD’S NAME	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	Food

Totals
FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /	FOOD*	Date / /
B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV	IN	OUT	B

AM

L

PM

S

EV
First Name

Last Name

DOB: / /
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
Absent

Health check
*B=Breakfast AM= AM snack L= Lunch PM= PM snack S= Supper EV= Night snack	Page totals B AM L PM S EV

2014-08-04