*If you are a family looking to receive a free Safe Sleep Baby Kit, please read the information below. Do not use this form.*

ECECD provides any expectant or newborn NM family it a Safe Sleep Baby Kit containing materials to foster a Safe Sleep environment in a variety of spaces. Our purpose is to provide all families in New Mexico access to and awareness of a Safe Sleep environment in a way that is respectful, culturally responsive, equitable, and informed. The Safe Sleep Baby Kit is distributed upon a family’s request by Home Visiting programs and partner agencies and organizations throughout our state. The kit includes a bassinet, infant clothing, baby board books, and educational materials about Safe Sleep, baby’s development, and resources available to families of young children in our state. The Safe Sleep Baby Kit is available to families regardless of income, home language, citizenship status, or family structure. To receive a free kit, contact your local Home Visiting program, found on our Early Childhood Education and Family Supports Portal by entering an address, or call 1-800-691-9067 to connect with a program. There is no obligation to sign up for the program to receive a kit. If you are an organization wanting to connect your families with free kits, please reach out to us at resourceandreferral@unm.edu or connect your families with a Home Visiting program in your area.

Safe Sleep Baby Kit Order Form

About You(Required)

If you are not an approved Home Visiting Program or Partner, please DO NOT use this form. You will need to call 1-800-691-9067 or email resourceandreferral@unm.edu to connect with a program that can give you the Safe Sleep Baby Kit. You can also visit search.newmexicokids.org to find a Home Visiting program yourself.

Home Visiting Program Name(Required)

Other Home Visiting Program(Required)

Direct FAMILY Delivery Only (ONE kit per baby will be sent directly to a family when a virtual Safe Sleep session was performed)

Please verify that the family who will be receiving the kit has participated in a Safe Sleep education session and that you have permission to share their name and address.

This is an order that needs to be shipped directly to a family. I certify that the family has participated in the Safe Sleep education curriculum indicated below and that I have the family's permission to share their name and address only for the purpose of mailing the kit.

Name on Shipment Package(Required)

Ship to Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County(Required)

Contact Name(Required)

Contact Phone(Required)

Contact Email(Required)

Hidden

Other Amount (Increments of 3)

Total Number of Dream on Me Bassinets Requested (indicate 0 if none)(Required)

Number of Baby Kits in English (indicate 0 if none)(Required)

Baby Kit includes reading materials such as brochures, flyers, and baby books available in English, Spanish, and other languages as well as infant clothing and consumer education materials.

Number of Baby Kits in Spanish (indicate 0 if none)(Required)

Baby Kit includes reading materials such as brochures, flyers, and baby books available in English, Spanish, and other languages as well as infant clothing and consumer education materials.

Other Languages Needed (please list language)

Baby Kit includes reading materials such as brochures, flyers, and baby books available in English, Spanish, and other languages as well as infant clothing and consumer education materials.

Other Languages Needed (please list number of kits)

Please note that while we strive to honor the home language of families and will do our best to fill orders with materials in other languages, we have limited supply and access to materials in a variety of languages.

Language of Family(Required)

English

Spanish

Other

Please list other language(Required)

Approximate age of baby at time of Safe Sleep session(Required)

prenatal

0 - 6 weeks

7 weeks - 3 months

4 - 6 months

Did family enroll in Home Visiting as a result of the meeting?(Required)

Family was already enrolled in Home Visiting

Family expressed interest in enrolling in Home Visiting

Family enrolled in Home Visiting because of the Safe Sleep visit

Family chose to participate in Safe Sleep visit only

Other

Notes

Information

Quick Links and Useful Information

Safe Sleep Baby Kit Order Form

Safe Sleep Baby Kit Order Form

Information

Quick Links and Useful Information

NM ECECD

Early Childhood Education and Family Services Portal

Moments Together NM

Am I Eligible Application for Child Care Assistance

YES NM Portal Application for Services