CONI opt-out form | The Lullaby Trust

Please use this form to notify us of families who are eligible to receive CONI support and either:

• decide not to take part in the programme or

• enrol on CONI but decline consent to share their details with the Lullaby Trust

Local coordinator ID

(If you don't remember your ID you can email the CONI Team at [email protected])

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Employer*

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If other, please specify

Baby's/Parent's details

Baby's month and year of birth/EDD*

Where do they live?*

Ethnicity of mother*

Please specify ethnic group

Participation information

Reason for offering the CONI Programme?*

If other, please specify

Reason for submitting this notification*

Please provide any additional details:

If other, please specify

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If yes, please specify reason

You can change the way you hear from The Lullaby Trust at any time by emailing [email protected] or calling 020 7802 3200

For information about how we collect, use and look after your details, please read our Privacy Policy

Please let us know about your connection with our work

This helps us to ensure that you receive communications that are appropriate and interesting to you.

If you selected 'Another reason', please share below

We promise to keep your details safe and secure. Please see our Privacy Policy for how we collect, use and look after your information. You can update your communication preferences at any time by emailing [email protected] or calling 020 7802 3200. By submitting your details, you are confirming you are over 18.