Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the provider number in the designated field to identify your child care provider.
3. Complete the name of the day care or owner/operator in the provided space. If applicable, fill in the on-site provider's name.
4. For each child, write their name and child number. Include the date of birth for all listed children.
5. Select the gender for each child by marking the appropriate box.
6. Indicate the ethnic information for each child by selecting one of the options provided.
7. Specify the racial information for each child by marking the relevant box.
8. List the primary language spoken at home in the designated space.
9. Check all applicable boxes to indicate if the child falls under certain categories, such as being a resident child or having special needs.
10. Fill in the date care begins along with time slots for care start and end times for each child.
11. Choose the days of the week that the child normally receives care and specify which meals are typically provided.
12. If applicable, provide the name of the school your child attends and whether they receive care on non-school days.
13. For infants under one year of age, complete the infant feeding statement by indicating who will provide infant food.
14. Input the parent/guardian's contact information, including names, email addresses, home address, and phone numbers.
15. Have the parent/guardian sign and date the form in the designated sections.
16. Review the completed form for accuracy, then save changes, download, print, or share as needed.

Complete your NY CACFP DOH-4419 form online today for a seamless enrollment process.