Person completing this form, Name *
Person completing this form, Name
Phone
Phone



 
Check the boxes of all recommendations the hospital is able to adopt within one year of today's date, or include an alternative completion date by month/year in comments:
  Cover MMH in birth class curriculum
 Provide MMH Information at discharge
 Policy/Procedure to protect and promote sleep
 Hospital staff who interact with new mothers have been trained in MMH
I agree to adopt the following recommendations by: *
Month
 
*
Year
 
Comments (optional)
 
I understand that the one-time registration fee of $269 is due 90 days upon receipt of the invoice, which will be delivered within 7-10 days via e-mail once this on-line adopter agreement is submitted. *
  Yes, I understand.
By checking this box, you are agreeing to the above responsibilities. *
Additionally, once this form is submitted, your organization will be added to our website, and considered a formal adopter as defined above.
  Adopt Now!