Register - Safe Baby Academy (Pack 'n Play Class)

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* This Field is Required

Are you over 6 months pregnant now? *
fill-in if baby has been born, leave blank if still pregnant
Income eligibility (must have an eligible income to receive a free pack 'n play. Check all that apply): *

(999) 999-9999


Please read the following agreement.

I realize registration for the Safe Baby Academy - Protecting Your Sleeping Baby class of Children's Hospital of Michigan is limited to those who are over 6 months pregnant or that are a caregiver of an infant less than 3 months old, and therefore I am qualified to attend.
I have not previously received a free Pack n' Play from any Children's Hospital of Michigan program, Department of Human Services (DHS) or Wayne County Department of Public Health.
I understand I must attend the entire class to be eligible to receive a Pack 'n Play.

I understand I am allowed to bring ONE (1) support person over 18 years of age, and NO CHILDREN are allowed in class.

The Safe Baby Academy - Protecting Your Sleeping Baby class will not allow any exceptions to the above terms and conditions.
I further understand that is ANY FALSE information is provided, I will not be eligible to attend any class by the Kohl's Injury Prevention Program in the future.
By checking this bow, I am confirming that all information is correct and I agree to the terms of the Safe Baby Academy - Protecting Your Sleeping Baby Participant Agreement.