Screen Reader Mode Icon

Sponsored by Safe Kids Columbus; led by Piedmont Columbus Regional Midtown

Welcome to the Application Process for the Safe Kids Columbus Virtual Safe Sleep Class held on ZOOM, that includes a free portable crib (pack & play) for eligible parents/caregivers. This educational program is taught by instructors who have received their Cribs for Kids Safe Sleep Ambassador certificate. The focus of this program is on education and teaching you how to keep your baby in a safe sleep environment.

Question Title

* 1. This course requires parents/caregivers to complete online pre and post surveys.

Question Title

* 2. How did you hear about the Safe Sleep Class?

Question Title

* 3. I understand that foster parents and non-custodial grandparents or relatives are not eligible for the free portable crib (pack & play).

Question Title

* 4. I am CURRENTLY enrolled in Medicaid (Example: Amerigroup, CareSource, Peach State, Unknown)
Be prepared to show your enrollment card at the start of the online class.

Question Title

* 5. I am CURRENTLY enrolled in WIC

Question Title

* 6. I am CURRENTLY enrolled in another financially screened program not listed for low-income individuals/families or have another potentially eligible circumstance I wish to share.

Question Title

* 7. I am NOT currently in a financially screened program but I am in need of a portable crib (pack & play) because...

Question Title

* 8. Are you or your parent partner a member of any branch of the military?

Question Title

* 9. I understand that if I do not qualify for the Safe Kids equipment, I am eligible to attend the class for educational purposes only.

Question Title

* 10. I understand that I must attend a 1-hour interactive safe sleep class in order to receive a free portable crib (pack & play).

Question Title

* 11. The following class guidelines must be followed. If you are not following these guidelines, you will be dropped from the class and rescheduled.

1. When you sign onto ZOOM, be prepared to show your ID and Medicaid/WIC card.
2. You must remain in one location during the entire class.
3. You cannot drive or be a passenger in a vehicle during class.
4. You cannot be actively working while attending class.
5. You are required to keep your camera on and be on screen at all times.
6. Proper attire for a classroom setting required.
7. No talking/texting during class unless speaking with the instructor.

Question Title

* 12. Contact Information: You must live in the following counties to participate - AL: Russell GA: Muscogee

Question Title

* 13. Child's Demographic

Question Title

* 14. From the list below, please select the best option for your situation

Question Title

* 15. Have you received a free portable crib (pack and play) from Safe Kids Columbus in the past 12 months?

Next Steps:
  • Applicants accepted into our program will receive an email confirmation with class date and time.
  • Monthly classes are held at 4pm online using ZOOM
  • Drive-thru portable crib pick-up date/time will be provided during your class.
0 of 15 answered
 

T