BUDS FORM Child's Name * First Name Last Name BOWL & URINE Were all bowel movements since the last lesson normal in consistency and schedule? * Yes No Was urine output more, normal, or less than usual in the hour after the last lesson? * More Normal Less Has urination frequency/amount been normal since the last lesson? * Yes No Explanation for any changes to bowel & urine: DIET Did your child have anything to eat or drink within the last two hours? * Yes No If yes, when and what did your child eat or drink? Did your child have any new foods given since the last lesson, as well as any reaction to the new food. * Yes No If yes please explain. SLEEP Was your child’s sleep/nap schedule typical since the last lesson? * Yes No Did your child fall asleep within 10 minutes of the last lesson? * Yes No Explanation for any changes to sleep: ACTIVITY Have there been any changes to your child’s activity/energy level or normal routine since the last lesson? * Yes No Has your child been swimming or in the water (other than bathing) since the last lesson? * Yes No Health Has your child had any illnesses, seizures fever >100.5, vomiting or skin rashes since the last lesson? * Yes No Has your child had any injuries or required any medical attention (including MD appts)? * Yes No Has your child taken any medication since the last lesson? * Yes No Explanation for YES answers and list ALL medications: Child’s temperature within one hour of lesson and/or 24 hour activity notes (if required) Do you have any questions or concerns about your child participating in lessons today, or about your child’s progression so far? Explanation for any missed lessons/lesson notes: Initial Here * Thank you!
