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  • Infant Safe Sleep Non-compliance Release Form

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This is to certify that I , the mother/father/guardian of minor child has been educated on infant safe sleep practices including specific SIDS (Sudden Infant Death Syndrome) risk reduction strategies,.

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How to fill out the Infant Safe Sleep Non-compliance Release Form online

Filling out the Infant Safe Sleep Non-compliance Release Form is an essential process for ensuring awareness of safe sleep practices for infants. This guide provides clear, step-by-step instructions to assist users in completing the form online.

Follow the steps to successfully complete the form online

  1. Press the ‘Get Form’ button to access the Infant Safe Sleep Non-compliance Release Form and open it in your editing tool.
  2. In the first blank field, provide your name as the mother, father, or guardian of the minor child.
  3. Complete the next blank field with the name of the minor child you are representing.
  4. Review the provided information regarding safe sleep practices, ensuring you understand the risks associated with unsafe sleep for infants under one year of age.
  5. Acknowledge your understanding of the risks by indicating your comprehension of the potential outcomes of non-compliance.
  6. Sign the form in the space designated for the authorized individual's signature.
  7. Indicate your relationship to the minor child in the corresponding section.
  8. Fill in the witness's details, including their signature, date, and time of signing.
  9. Select the appropriate options for the hospital name, zip code, state, and country as specified in the form.
  10. Once all fields are completed, save your changes to the document. You may also download, print, or share the form as needed.

Complete the form online to ensure your understanding of infant safe sleep practices.

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Place infants on their backs for sleep in their own sleep space with no other people. Use a crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).

A B C – ALONE, BACK, CRIB  Baby should sleep alone, in a safe crib or play yard, in the same room as the caregiver.  Baby should always be put down to sleep on his/her BACK.  The risk of SIDS is much higher when a baby sleeps on his/ her tummy or side.

Place infants on their backs for sleep in their own sleep space with no other people. Use a crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).

The new guidelines include quite a few changes, like not using car seats, strollers, swings and infant carriers for routine sleep. Parents are also encouraged to sleep in the same room, but not in the same bed as their baby, preferably for the first six months.

SIDS is less common after 8 months of age, but parents and caregivers should continue to follow safe sleep practices to reduce the risk of SIDS and other sleep-related causes of infant death until baby's first birthday. More than 90% of all SIDS deaths occur before 6 months of age.

Even though the thought can be deeply unsettling, experts agree that there aren't any warning signs for SIDS. And since SIDS isn't diagnosed until after an infant has died and the death has been investigated, you can't catch SIDS while it's happening and stop it, for instance, by performing CPR.

SIDS is defined as the sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history [2,3].

Safe Sleep Policy Always put infants to sleep on their backs unless you provide Form 3019, Infant Sleep Exception/Health Care Professional Recommendation, signed by the infant's health care professional [§746.2427 and §747.2327].

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