Introduce Yourself and Explain That This Information Is Part of a Program to Reduce The

Shaken Baby Syndrome Prevention Program Voluntary Commitment Statement o I learned that infant crying is normal and received tips on how to cope with it. o I learned about local resources including the New Parent Support Program, and that I can call Military OneSource (1-800-342-9647), which is available toll-free, 24 hours a day, 7 days a week, if I need support to cope with my child’s crying. o I have viewed Portrait of Promise, and I understand that violent shaking is harmful and potentially deadly to a baby. o I have received information about Shaken Baby Syndrome, and have been asked to voluntarily sign a commitment statement acknowledging that I understand this information. o I learned how important it is for me to share what I have learned with all of my child’s caregivers.

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______Hospital Representative Date