Bereaved Families Panel

Name*

First Last

Email*

Phone*

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

What is your gender?*

If you prefer to self-describe please provide this here

Age range*

Please choose one option that best describes your ethnic group or background

White

English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any other White background

Mixed / Multiple ethnic groups

White and Black Caribbean
White and Black African
White and Asian
Any other Mixed / Multiple ethnic background

Asian / Asian British

Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background

Black / African / Caribbean / Black British

African
Caribbean
Any other Black / African / Caribbean background

Other ethnic group

Arab
Any other ethnic group

Please specify ethnic group

Panel members need to be more than 2 years past their bereavement. Please give the date of your child’s death*

Name of the baby who died*

What is your relationship with the child who died?*

If other - please specify here

How old was your baby/child when they died?*

Which of these most closely describes your baby or young child's cause of death?*

Other (please tell us)

Have you used the LT bereavement service, including CONI support, before?*

If Yes, please specify which service

Volunteering as a Bereaved Families Panel member

Please note this is not a support group and we ask you are at least 2 years bereaved and feel comfortable talking about bereavement without it becoming a trigger for you.

The commitment of the Bereaved Families Panel is to take part in 3 meetings a year (online) with ad hoc requests for help with resources, campaigns, consultation via email as and when.

What would you like to get from the Bereaved Families members panel?*

If Other, please let us know what you would like to get from this experience:

Please tell us – is a few words (no more than 25 words) why you would like to be part of this group?*

We are always looking for families to be part of our film campaigns. Would you like to be involved?*

Bereaved Families Panel Code of Conduct

Every member of the Bereaved Families Panel must:

1. Treat each other as an individual.

2. Support each member’s own individual choice about their own involvement within the Bereaved Families Panel.

3. Respect each person’s personal views and wishes.

4. Respect and maintain the dignity and privacy of members of the Bereaved Families Panel.

5. Respect diversity and different cultures and values and experiences of all members of the Bereaved Families Panel.

6. Be honest and trustworthy.

7. Communicate in an appropriate, open, accurate and straightforward way whilst making sure their actions, opinions and/or behaviour does not affect themselves or others in a negative way.

8. Be reliable, dependable and honour commitments, agreements and arrangements and, when it is not possible to do so, let the support team know.

9. Declare issues that might create conflicts of interest.

10. Strive to support the Lullaby Trust to the best of your ability and for the time indicated when you initially signed up, unless otherwise indicated to the Support Team.

Our promise to you as the professionals involved in the Bereaved Families Panel :

1. We will respect and, where appropriate, promote your individual views and wishes, working openly and co-operatively with all members.

2. We will promote equal opportunities for all members.

3. We will maintain confidentiality of all personal information. All information about you will be held in accordance with our Privacy Policy. See our privacy policy on our website for how we collect, use and look after personal information at https://www.lullabytrust.org.uk/privacy-cookies

4. We will respect all responses and remain impartial and non-judgemental whilst clearly explaining policies about confidentiality, the breaking of confidentiality, and the reporting of dangerous, abusive, discriminatory or exploitative behaviour. We will not tolerate abusive or inappropriate behaviour or language being used within the group; you may be asked to leave the group.

5. We will uphold public trust and confidence in the Bereaved Families Panel by acting in a lawful, safe and effective way.

6. We will be accountable for maintaining and improving the quality of the Bereaved Families Panel work.

7. We will protect the rights and promote the interests of all members, taking compliments and complaints seriously and responding to them by passing them to the appropriate person.

8. We will strive to establish and maintain the trust and confidence of all members.

By agreeing, you are confirming that you:

• Will abide by ‘Bereaved Families Panel Code of Practice'

• Understand the role and responsibilities of the Support Team staff involved with the Bereaved Families Panel

Do you agree with the Bereaved Families Panel Code of Practice?*

Keeping in touch

At The Lullaby Trust, we’re determined to do all we can to save more lives. We can’t do this without the help of our supporters, which is why we’d like to keep in touch with you about our vital work, news and opportunities to support us.

Please confirm below how you want to hear from us in future

Email*

Post*

Phone*

Text message*

You can change the way you hear from us at any time by emailing us or calling 020 7802 3200. Please also see our Privacy Policy for how we collect, use and look after your information.

Email

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

Bereaved Families Panel

Bereaved Families Panel – Registration Form

Volunteering as a Bereaved Families Panel member

Bereaved Families Panel Code of Conduct

Every member of the Bereaved Families Panel must:

Our promise to you as the professionals involved in the Bereaved Families Panel :

By agreeing, you are confirming that you:

Keeping in touch

I need information

I need support

I want to help