Grandparent Participation Form


Dear Grandparent


We believe in you. We believe in your desire to protect that which is most precious and dear to you. We value and respect your ability to influence others in your family and community to promote infant protection and speak out about safe sleep for babies.

For you to fully participate in this project we ask that you:
  1. Talk to people. Have lots and lots of safe infant sleep discussions with other grandparents, family and friends - men and women, young and old, now and forever! (see Grandparents Talk Card and "What you need to know about babies")
  2. Pass it on. Ask the people you talk to, to pass it on and help more people to understand
  3. Keep a record
  4. Fill in the details below (your information helps us to evaluate this work)

A. i) Name (first name)        
    ii) Are you male  female  
    iii) Are you a grandparent?   yes  no   
    iv) what ethnicity do you belong to?     

B. What is the name of the person who spoke with you about this project? (first name)     
C. Please provide details of your first 10 safe infant sleep discussions that you have had:

        People
     (first name)

          Date 
  of each discussion 

         Comment 

1.     
2.     
3.     
4.     
5.     
6.     
7.     
8.     
9.     
10.    

D. How much have you enjoyed being part of this project? 1= low, and 9 = high

    1     2     3     4      5      6      7     8      9 

E. Describe a high point or best moment in your discussions, eg a time when a discussion went well, when you felt confident,
or felt that what you are part of is important



F. If you would like to be kept up to date about this project please provide us with your email address



We value your feedback and your participation. Thank you for taking this lead in your community to protect the lives of New Zealand babies