Safe Sleep Training Registration – Infant Loss Resources
Register to learn safe sleep practices and access support resources.
Basic Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip Code
*
Child / Pregnancy Information
Are you currently pregnant or expecting?
*
Yes
No
If yes, what is your due date?
-
Month
-
Day
Year
Date
How old is your child?
*
Newborn (0–3 months)
Infant (3–6 months)
Infant (6–12 months)
Toddler (1+ years)
Not applicable
Safe Sleep Needs
What is your primary reason for attending this training?
*
Do you feel confident in your current safe sleep practices?
*
Yes
Somewhat
No
Are you in need of a Pack n Play?
*
Yes
No
After this training, do you think you will need additional support or resources related to safe sleep?
*
Yes
No
Not sure
If yes, what kind of support would be helpful?
Safe sleep education materials
One-on-one guidance
Access to baby supplies (crib, bassinet, etc.)
Community support
Other
Program Interest
Are you interested in any of our other programs?
Holding Space (Grief Support)
Group Support Sessions
One-on-One Support
Community Events
Volunteer Opportunities
Educational Workshops
Not at this time
Attendance
How did you hear about this training?
*
Social media
Referral
Hospital / provider
Website
Community organization
Other
Would you like someone to follow up with you personally?
Yes
No
Best way to contact you?
Call
Text
Email
Consent & Terms
Register
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