CONI Notification of Non-Participation Form

"*" indicates required fields

It is important for us to record as accurately as possible the number of families who decline CONI, or are supported by the CONI programme but do not wish their details to be shared with The Lullaby Trust

Please use this form to notify us of families who are eligible to receive CONI support but

• decide against using the programme or

• who enrol on CONI but decline consent for details to be shared with the Lullaby Trust

Local Coordinator ID

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

Employer*

If other, please specify

Baby's/Parent's details

Baby's month and year of birth/EDD*

Where does the mother live?

County*

If other, please specify

Postcode*

Reason for offering the CONI Programme?*

If other, please specify

Family are enrolled but do not wish information to be shared with the Lullaby Trust*

Yes

Parents have decided against using CONI*

Yes

If yes, please specify reason

Todays date*

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