Works almost 100% out of the box. The only drawback is the type of packaging. They use a zip bag to ship it. When we got the bunk there was a huge crease in the pillow that you put the baby on and wouldn't come out. I had to take the pad apart, massage it and roll it in opposite directions to get it to lay flat. Took me about 20 minutes to fix, if using a vacuum bag this would never have been an issue. Otherwise it works great.
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