RBC Confidant Care: Covid-19 Emergency Support Application
Rosemary’s Babies Company Confidant Care Support allows our organization to provide 24/7 financial, emergency and emotional support for teen parent families, moms and dads (13-19), in the tri-state area (Ohio, Kentucky, Indiana). This service is free of charge ($0.00).

Families are able to contact Rosemary’s Babies virtually:
Call or Text: (513) 813-TEEN (8336)
Email: rosemarysbabies.cincy@gmail.com
Website: www.rosemarysbabies.co
Social platforms: Facebook, Instagram, Twitter, Google, LinkedIn
Email address *
Today's Date *
MM
/
DD
/
YYYY
First Name *
Last name *
Address *
City *
Zip Code *
Please list your neighborhood *
Phone Number *
How would you prefer to be contacted *
Required
If social media, what is your name (username) on social media? Which platform i.e. IG, FB, Google, LinkedIn, SnapChat, Twitter
Age: List the age of the applicant *
Sex *
Birthday: List the birthday of the applicant *
Are you: *
Background: Teen Parent: How many children do you have, sex, age. Pregnant teen: Due date, sex of baby, *
Who do you live with? *
What is your occupation? *
Required
If employed, where do you work and what is your hourly salary?
Were you impacted by the COVID-19 crisis or do you just need support?
Clear selection
Rosemary's Babies provides emergency resources for families during this time, during and after child-birth.
On a scale from 1-5 how do you feel emotionally during this crisis? *
Depressed I need to talk to someone
I am in a good space and feel healthy
Would you like to speak with someone about your health and well-being? *
Emergency Transportation
During these times you or your baby may have medical appointments or need transportation to a family or friends. Transportation support can be rideshare, bus card/token or Uber, Lyft or other means. A household/family should not exceed more than $30 per month for transportation.
Do you need emergency resources? Transportation for medical appointments is limited to 1 in any one week period (Max $15 per ride one way)Transportation to a family or relatives is limited to 1 ride monthly (Max. $15 per ride one way)Transportation for missing the bus to work is limited to 1 ride monthly (Max $15 per ride). A family should not receive more than $30 maximum per month for transportation.
Clear selection
Emergency Resources
Emergency Resources: The nation is currently in a state of emergency. We are able to help in the following areas for families. A household/family should not exceed more than $50 in emergency resources per month.
Do you need emergency resources? $25 (Max Monthly) Cleaning, house, personal supplies include but not limited to: toilet paper, cleaning supplies, feminine hygiene products, laundry detergent$25 (Max Monthly) Children’s needs including but not limited to diapers, baby milk $50 (Max Monthly) Food: this support may be given via gift card or cash card. A household/family should not exceed more than $50 in emergency supportive resources per month.
If financial support is provided do you have one of the following electronic
Clear selection
Household | Utility | Other resources
Housing and resources are vital for young families in times of this nationwide emergency and throughout the year. Rosemary’s Babies will provide support for those families facing disconnection, eviction, and other similar issues based on individual circumstances.
Explain your needs for household | utility | other resources
If you are under 18, what is your parent or guardians name, phone &/or email
Does your parent or guardian know you have contacted Rosemary's Babies Company for support? (Responding "no" does not disqualify you for support?) *
Are you affiliated with Rosemary's Babies? *
Who referred you to Rosemary's Babies for Confidant Support? *
Is there anything other than the services listed above we can help you with?
Electronic Signature
By signing below, I certify all information is true and correct to the best of my
knowledge.
Please print your name as verfication to submit *
Date *
MM
/
DD
/
YYYY
Please allow Rosemary's Babies up to 72 hours (3 days) to respond to your request. If you have an immediate need that you are unable to wait for a response, please text/call (513)813-8336
These funds for services are distributed on a case by case basis at the discretion of the agency and are not guaranteed as they are based upon availability of resources.
Rosemary's Babies Company is a teen parent and family support organization
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Rosemary's Babies Co. Report Abuse