TheRareOproject Diaper Program Request Form
Hi Momma 🌸

Thank you for reaching out to us.

This form is for diapers, wipes and formula (if available) only. You must be a young parent between the age 14-25.

Please check your email for confirmation within 48hours of your request.

Please be prepared to provide identification of yourself and birth certificates for the children you’re requesting essentials for.

All requests are pickup only at this time!

Diaper sizes available - NB - 7

Please Note:
🌸1 box per month per family.
🌸1 package of wipes per family.
Email *
Date *
Name *
Age *
Address *
Zip code *
Phone number *
How many children do you have in diapers? *
What size diapers are you requesting? *
Marital Status? *
Are you currently receiving any public assistance? *
If yes to receiving public assistance, please share which government assistance program’s are you a participant of? *
Required
Annual income? *
Required
What baby essentials are you requesting? *
Required
Household size? *
Are you available to pick up in Leimert Park(south LA) area? *
Required
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