Safe Sleep Pack N Play Giveaway

Pack N Play Giveaway Entry Form
Please complete the entry form below to be registered to win a free Pack N Play. You may enter once per month, and winners will be notified by phone or email.

• The information gathered will be used to improve our Safe Sleep Initiatives and messaging for the future; your responses to each question will help us keep babies safe throughout Ohio. Please answer as many questions as possible.

Name (First and Last)

Email

City, State ZIP

Phone Number

Ohio County (if not from Ohio, select "N/A") Adams Allen Ashland Ashtabula Athens Auglaize Belmont Brown Butler Carroll Champaign Clark Clermont Clinton Columbiana Coshocton Crawford Cuyahoga Darke Defiance Delaware Erie Fairfield Fayette Franklin Fulton Gallia Geauga Greene Guernsey Hamilton Hancock Hardin Harrison Henry Highland Hocking Holmes Huron Jackson Jefferson Knox Lake Lawrence Licking Logan Lorain Lucas Madison Mahoning Marion Medina Meigs Mercer Miami Monroe Montgomery Morgan Morrow Muskingum Noble Ottawa Paulding Perry Pickaway Pike Portage Preble Putnam Richland Ross Sandusky Scioto Seneca Shelby Stark Summit Trumbull Tuscarawas Union Van Wert Vinton Warren Washington Wayne Williams Wood Wyandot N/A

Age of Baby Less than 1 Month 1 – 2 Months 2 – 3 Months 3 – 4 Months 4 – 5 Months 5 – 6 Months 6 – 7 Months 7 – 8 Months 8 – 9 Months 9 – 10 Months 10 – 11 Months 11 – 12 Months Greater than 12 Months I don't have a baby.

Relationship to Baby ---- Mother Father Grandparent Caregiver N/A Other

Other

How did you hear about the safe sleep campaign?

Radio

TV

Transit Print Ad (Bus)

Online

Social Media

Healthcare Professional

Other

Please check all that apply.

Which best describes the location(s) of the Healthcare Professional that shared this message with you? *

Birthing Hospital

Children's Hospital

Primary Care Office

Other *

If you are human, leave this field blank.