Partner Application Form


To start a Cribs for Kids® Chapter in your area, please complete the ‘Partner Application Form’ below and submit your request.  You will be contacted by phone or by e-mail with information on how to proceed.  The Trademark License Agreement is provided on the sidebar for your review.  Once your Trademark License Agreement has been completed and submitted you will be an official Cribs for Kids® partner!  Please feel free to contact Judy Bannon at 412-322-5680 Ext. 3 or jbannon@cribsforkids.org  with any questions.

If you are a mother in need of a safe sleep environment for your baby, please do not complete this application.  Please go to Request a Crib

* Indicates Required Field

Your Contact Information:

First Name *

Last Name *

Credentials

Title of Contact Person*

Organization Name*

Address*

City*

State*

Zip*

Phone*

Fax

Your E-mail*

Website

Tax ID# (EIN)

Date of Incorporation

_______________________

Are you the contact person for your Cribs for Kids® Program? (if yes, skip to next section)
YesNo

If not, please provide the name, phone number and e-mail address of the contact person:

First Name

Last Name

Credentials

Title of Contact Person

Phone

Fax

Your E-mail

________________________________

Please provide the following information for your company/organization:

Scope & Mission of your organization*

Describe how Cribs for Kids® will further the mission and focus of your organization*

What community resources are available that will enhance the Cribs for Kids® program (i.e., funding for cribs, home visiting agencies, etc.)?*

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