BCHD_Cribs Block Grant Eligibility Form

WELCOME!

We’re proud to offer 20 cribs this year to families who need a safe sleep space for their baby. This opportunity is made possible through a one-time special grant, and cribs will be shared with eligible families while supplies last. Please complete the form below so we can review your eligibility.

*These cribs are intended for those who require a primary sleep space for their baby, where the baby currently resides & sleeps.

1. Are you a Bourbon County Resident? *This question is required.

2. Please enter your zip code. *This question is required.

3. Guardian Name *This question is required.

Have your baby (or babies) been born?

*This question is required.

Expected Due Date for Baby (or Babies)

*This question is required.

Baby (or Babies) Date of Birth

*This question is required.