High 5
for Mom and Baby

Hospital Agreement and Application Form

To apply, please complete this fillable Adobe PDF application form and agreement, print, and mail to program coordinator Gwen Whittit at 1840 Trail End Drive, Goddard, KS 67052.

Please be sure to forward copies of any/all current breastfeeding policies from your hospital as well. Thank you for your interest in the High 5 for Mom & Baby Program.




The role of hospitals in
breastfeeding success

The importance of breastfeeding

Current breastfeeding rates
in Kansas

The High 5 practices

Participating hospitals

Helpful information


About us

About our program

Resource area

Contact us


Best practices. Best health outcomes. Best for Mom and Baby!