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Apply to become a Breastfeeding Friendly Premises

To become a Breastfeeding Friendly Premises means that you welcome and support nursing mothers. This way, mother can breastfeed without worries and give the best nutrition to the next generation. If you company / organization pledges to participate in 2021/2022 Say Yes To Breastfeeding Community Support Action, please fill in the following details.

Contact Information:
Name of the Company/
Organization*:
(Chinese)
(English)
Contact Person1*:
(Surname)
Contact Person1*:
(Given Name)
Contact Phone Number*:
Contact Email Address*:
Contact Person2:
(Surname)
Contact Person2:
(Given Name)
Contact Phone Number :
Contact Email Address :
Mailing Address*:
Company's or
Organization's website*:
Number of Employees:
Number of premises (one company address means one premises):
Categories:
Is your company / organization interested to accept periodic communication from UNICEF HK?
Interested
If UNICEF HK organizes activities to promote breastfeeding or early childhood development?
Interested
The type of UNICEF HK activities your company / organization are interested to support
Corporate training on early childhood development or family friendly policies
Corporate events on work-family balance
Corporate volunteer activities
Other UNICEF activities (e.g. Charity Run)
Are you applying for the Gold Label (with a breastfeeding room)?
(skip to the next step)
To become a Breastfeeding-friendly Premises with Gold Label, your company / organization will undertake the following
Yes No
Do not disturb a breastfeeding mother (e.g. will not ask to cover her body or ask her to breastfeed at another location)
Will not ask a mother to breastfeed in the toilet
Provide training about breastfeeding to employees to raise their awareness
Provide assistance to mothers in need (e.g. explaining their needs to other customers)
To become a Breastfeeding-friendly Premises with Gold Label, your company / organization will undertake the following
About Breastfeeding Rooms
Yes No
Clean breastfeeding room/area regularly Provide sanitizing utensils, e.g. hand sanitizer and/or antiviral wipes
Provide breastfeeding space (E.g. fitting room, lounge area, space
Provide a comfortable chair with armrest
Provide an electricity socket for breast milk collection
Provide sanitizing utensils (E.g. hand sanitizer and/or antiviral
Provide facilitaties to change diapers (Including trash bin with lid)
Provide additional assistance if the mother requires help
Display educational material on hygiene
Acknowledge the newly amended “Sex Discrimination Ordinance” (The provisions relating to breastfeeding discrimination will come into operation on 19 June 2021.)
Premises Detail :
Premises Name *:
(Chinese)
(English)
Premises Address *:
Premises Telephone *:
Breastfeeding Room:
Breastfeeding Openning:
Whether the establishment provides breast milk storage service (with a separate refrigerator at 2-4°C):
Are you applying for the Blue Label (with a breastfeeding room)?
To become a Breastfeeding-friendly Premises with Blue Label, your company / organization will undertake the following
Yes No
Acknowledge the newly amended “Sex Discrimination Ordinance” (The provisions relating to breastfeeding discrimination will come into operation on 19 June 2021.)
Display educational material on hygiene
Provide additional assistance if the mother requires help(e.g. explaining their needs to other customers)
Provide training about breastfeeding to employees to raise their awareness
Will not ask a mother to breastfeed in the toilet
Do not disturb a breastfeeding mother (e.g. will not ask to cover her body or ask her to breastfeed at another location)
Respect mother's freedom to choose where to breastfeed and will not restrict the freedom of the mother; display a welcoming attitude and allow the mother to breastfeed anywhere they choose
If mother in need, please arrange a private and comfortable space for breastfeeding, which is:
Changing Room
Resting Area
Lounge Area
Sofa Area
Space with Some Privacy
其他:
Premises Detail :
Premises Name *:
(Chinese)
(English)
Premises Address *:
Premises Telephone *:
Breastfeeding Room:
Breastfeeding Openning:
Whether the establishment provides breast milk storage service (with a separate refrigerator at 2-4°C):

Statement:
The Hong Kong Committee for UNICEF promises to protect your privacy:. The Hong Kong Committee for UNICEF ("UNICEF HK") collects, uses and stores your personal data in accordance with the Personal Data (Privacy) Ordinance. UNICEF HK will use the information you provide on this form to send you children's right, breastfeeding and parenting information, as well as occasional updates about the latest work of UNICEF and UNICEF HK, including ways you can support children in need around the world. We will endeavour to protect your privacy when we collect, use and store your personal data. You can unsubscribe at any time if you do not wish to receive our communication in future. To learn more about our Privacy Statement please visit
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UNCIEF HK will issue a Certificate of Appreciation after reviewing and approving

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