Let's Unite Moms - Donations Request Form

We are moms who care deeply about the moms in Queens, County, NY. This form helps us understand how we can best support you and your family.

Firstname *
Lastname *
Contact Number *
Email Address *
Address *
Age and Gender of Child(ren) *
Diaper, shoe and clothing sizes *
Food Requests and Dietary Requirements/Restrictions *
What type of support do you need right now? 
Basic essentials for mom & children - personal hygiene products, diapers, baby food, non perishable food, community resources etc) Be specific.
Can you share a little about your current situation and how we can best support you? We're here to help!
How did you hear about us?
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