Bedtime bundles referral form

The Lullaby Trust will be providing 400 vulnerable families, living in temporary accommodation or crisis situations, with essential safer sleep items for their baby.

Every baby needs access to a cot or Moses basket, yet sadly too many babies in temporary accommodation don’t have one.

Below you will find a referral form for our new project; Bedtime Bundles.

Each bundle will contain:

  • Travel cot
  • Cot sheet – Kindly donated by brand partner Folk & Thread
  • Baby sleeping bag – Kindly donated by brand partner Folk & Thread
  • Thermometer
  • Safer sleep leaflets

Bedtime Bundles Referral Form

"*" indicates required fields

Health Care professional details

To be completed by Health Care professional.
Consent*
Consent*
As The Lullaby Trust is not the manufacturer of the products in the Bedtime Bundle, unless the law provides otherwise, The Lullaby Trust holds no responsibility for individual products enclosed or any accidents, or injury which occur whilst using items. 

Parent/Carer details

To be completed by Health Care professional on behalf of family.

Baby's details

To be completed by Health Care professional on behalf of family.
DD slash MM slash YYYY
DD slash MM slash YYYY

Additional information about the family

For monitoring purposes only. To be completed by Health Care professional on behalf of family
Is the Parent/Carer claiming asylum?*
Does the parent/carer have a disability?*

Referral

To be completed by Health Care professional.
Reason for referral*
Accommodation*
Parent/Carer preferred method of contact from The Lullaby Trust (please tick all that apply):
This field is for validation purposes and should be left unchanged.