CONI enrolment form | The Lullaby Trust

Comments

This field is for validation purposes and should be left unchanged.

Please complete the form below to enrol in the Care of Next Infant (CONI) programme. This form should be completed by the CONI Co-ordinator with the parent(s).

Snuza Hero MD monitors and Angelcare AC25-1 monitors are currently AVAILABLE. Check here for stock updates.

Your CONI coordinator ID*
Please enter a number from 1 to 1000000000.
If you don't remember your ID please contact CONI team at [email protected]

Your CONI coordinator work email*

Employer*

Parent's details

Where does the mother live?*

Please specify*

Please specify which London Borough*

What is the mother's full postcode?*

Baby's details

Expected date of delivery or date of birth*
DD slash MM slash YYYY

Birth weight
Please state kilograms

Additional information about the family

Main language spoken by parent(s) at home

Ethnicity of the mother

Please choose one option that the mother says best describes her ethnic group or background

Ethnicity of the mother*

Please specify ethnic group

Reason for providing CONI support

If yes, how old was the baby who died?
Please specify age in MONTHS, WEEKS and/or DAYS

If the parents haven't experienced the sudden unexpected death of a baby, please provide the reason for their CONI support

Other reason for CONI support

Please ensure that you have consent from the family to share this information so please ensure that you complete the section at the end of the form. The monitor will be sent directly to the parent(s) as the monitor is their property. Please advise them of this. Please discuss this arrangement with your manager who should seek local legal/governance advice If this is not possible/advisable or no consent to share contact details, then the monitor will be sent to the coordinator to be provided for the specific baby.

Parent's name

Please provide your (the parent's) mobile number to receive a welcome text from The Lullaby Trust CONI Team and a text with a link to a short Feedback Form at the end of the programme

Please provide your (the parent's) first name so we can address the text to you

Thank you so much for taking the time to give us your information. It will be used to monitor the effectiveness of the CONI programme and to make improvements to it for future parents, and to improve Lullaby Trust services, for example fundraising for The Lullaby Trust and the CONI Programme. You can change the way you hear from The Lullaby Trust at any time by emailing [email protected] or calling 020 7802 3200. Please also see our privacy policy on our website for how we collect, use and look after your information.