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West River Head StartNutrition Screening Questionnaire
(children 35 years old)
Today's date:Child's DOB:Child sage:Child's name:
Health problems/concerns:
Medications:How is your child eating and
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What is children 3-5 years old?
Children 3-5 years old refers to kids within this age range.
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Parents or legal guardians of children 3-5 years old are required to file.
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