CoH Portable Crib Release


I certify that the information provided in this application is true.  I authorize Cradle of Hope and Agency representatives to verify and communicate any information contained in this application or about my situation to assist me.  I also certify that Safe Sleep information has been reviewed with me.  In exchange for receiving a portable crib, I agree to indemnify, defend and hold harmless Cradle of Hope, its subsidiaries, employees, agents, and contractors and its designated representatives and employees, from all claims, losses, damages, injuries, costs, and expenses arising out of any act or omission involving the placement and/or use of the portable crib, sheet set, or SleepSack.  Applicant agrees that this agreement is binding on all heirs, successors, and assigns.

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Signature Certificate
Document name: CoH Portable Crib Release
lock iconUnique Document ID: 3cfcb4410018c346359688f4095327e41389941d
Timestamp Audit
April 14, 2020 12:30 pm CSTCoH Portable Crib Release Uploaded by Darlene Kopesky - dkopesky@cradleofhope.org IP 73.62.185.83
April 14, 2020 12:33 pm CSTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
April 14, 2020 12:33 pm CSTCynthia Godin - cgodin@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
April 14, 2020 12:33 pm CSTChristina Solensten - csolensten@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
June 11, 2021 4:25 pm CSTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 68.98.116.57
June 11, 2021 4:25 pm CSTCynthia Godin - cgodin@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 68.98.116.57
June 11, 2021 4:25 pm CSTChristina Solensten - csolensten@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 68.98.116.57
September 14, 2021 3:15 pm CSTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
September 14, 2021 3:15 pm CSTCynthia Godin - cgodin@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
September 14, 2021 3:15 pm CSTJennifer Hagenauer - jhagenauer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 24.118.77.131
June 6, 2022 2:01 pm CSTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83
June 6, 2022 2:01 pm CSTCynthia Godin - cgodin@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83
June 6, 2022 2:01 pm CSTMary Greger - mgreger@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83
November 28, 2022 1:26 pm CSTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83
November 28, 2022 1:26 pm CSTCynthia Godin - cgodin@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83
November 28, 2022 1:26 pm CSTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.62.185.83