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Thank you for your interest in attending the Ellis County Community Baby Shower. Participants completing Safe Sleep® instruction and pre and post tests will receive a portable crib and sleep sack. Please answer the following questions so we can better serve you and have a portable crib and sleep sack reserved for you.
Event Details:
Date: Saturday, April 5, 2025
Time: Come and go between 11:00AM-12:00PM Education Sessions will run every 15 minutes from 11:15am-12:45pm
Location: St. Nicholas Church, 2901 E 13th St, Hays, KS 67601
If you have any questions share them below or contact Monique at 785-628-9430 or moniquek@ksu.edu
First Name
Last Name
Mother/Father Date of Birth
Gender
Male
Female
Non-binary / third gender
Prefer not to say
Race-Select all that apply
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Unknown
Ethnicity- select one
Hispanic or Latino
Not Hispanic or Latino
Choose not to provide/unknown
Primary Language
English
Spanish
Other
Phone Number
Email Address
Baby's Due Date or Birth Date
Do you have KanCare United Healthcare? If so, you will visit the United Healthcare resource table to recieve your portable crib for paticipating in Safe Sleep instruction!
Yes
No
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