Connection Survey - A - The Lullaby Trust

Please enter your Supporter ID - you can find this on the email containing the link to this survey.*

Name*

First Last

1. Have you, or someone you know, been affected by the death of a baby or young child?*

Yes - Stillbirth
Yes - Neonatal death
Yes - Sudden infant death
Yes - Other cause of death
No

Which of the following best describes you?

Bereaved Parent of a baby or young child
Bereaved Grandparent of a baby or young child
Bereaved Sibling of a baby or young child
Bereaved Relative of a baby or young child
Friend of a family bereaved of a baby or young child
Other bereavement of a baby or young child

Would you like to tell us a little about your baby who died?

Your baby's name

Your baby's date of birth

DD

MM

YYYY

Your baby's date of death

DD

MM

YYYY

Would you like to tell us a little about your grandchild who died?

Your grandchild's name

Your grandchild's date of birth

DD

MM

YYYY

Your grandchild's date of death

DD

MM

YYYY

Would you like to tell us a little about your sibling who died?

Your sibling's name

Your sibling's date of birth

DD

MM

YYYY

Your sibling's date of death

DD

MM

YYYY

Would you like to tell us a little about your baby relative who died?

What is your relationship to the baby?

Your baby relative's name

Your baby relative's date of birth

DD

MM

YYYY

Your baby relative's date of death

DD

MM

YYYY

Would you like to tell us a little about the family friend's baby who died?

The baby's name

The baby's date of birth

DD

MM

YYYY

The baby's date of death

DD

MM

YYYY

Would you like to tell us a little about the baby who died?

The baby's name

The baby's date of birth

DD

MM

YYYY

The baby's date of death

DD

MM

YYYY

What is your relationship to the baby?

2. Do you currently use, or have you ever used, The Lullaby Trust's safer sleep advice to care for a baby or young child under 1 year old?*

Yes
No

What is/was your relationship to the baby being cared for?

If you selected 'Other' above, please expand on your answer.

When is the baby due or when was their birth date? If you have several children in the family, please tell us the birth date of the youngest.

DD

MM

YYYY

3. Are you a professional working with families?*

Yes
No

Which of these best describes your job?

If you selected 'Other' above, please expand on your answer.

4. If you have answered 'No' to questions 1-3 please tell us about your interest in and/or connection to our work.

4. Is there anything else you'd like to tell us about your interest in our work?

Your connection with our work

I need information

I need support

I want to help