Kansas Hospitals and Birth Centers: use this streamlined online form to apply for renewal of recognition as a High 5 for Mom & Baby Premier facility. If helpful, you can download an offline sample to gather the information to enter into the official online form below.
If you have questions about High 5 for Mom & Baby or the renewal process, please contact program coordinator Cara Gerhardt coordinator@high5kansas.org. Thank you for your continued commitment to helping ensure successful breastfeeding for Mom & Baby!
Note: upon submission of the below form, an email confirmation will be sent to the address entered in the email field below. If you want to save a partial form for later completion, please use the Save Draft function at the bottom of the form.