CONI enrolment form

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).

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*

Where does the mother live?*

Please specify which London Borough*

What is the mother's full postcode?*

Expected date of delivery

OR Date of Birth

Birth weight

Please state kilograms

Additional information about the family

Mother's number of previous pregnancies

Please enter a number from 0 to 20

Mother's age now

Please enter a number from 10 to 50

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 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

Date

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.

Name

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

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.

Parent's details

Baby's details

Additional information about the family

Ethnicity of the mother

Reason for providing CONI support