El Paso, TX Site
Kit and/or mentor application
Your Full Name *
Your answer
Facebook Profile URL or FB Name *
Your answer
Your E-mail Address *
Your answer
Your Physical Address *
Your answer
Your Phone Number *
Your answer
How do you want to be contacted?
What are you applying for? *
The name, relationship, and phone number of one reference person who does not live with you. *
Your answer
Are you currently cloth diapering? *
Do you own any cloth diapers at all? *
If you answered yes to the previous question, how many cloth diapers do you own. *
Your answer
If you do own some cloth diapers, why would you like to borrow our kit of diapers? *
Your answer
Are you planning on moving, pcsing, or traveling for an extended period of time (longer than 2 months), outside of this site's 90 minute radius anytime soon? *
Your answer
Child(ren) information *
Age, Weight, and Gender (if known)
Your answer
Do you currently have to choose between buying diapers and other essential items such as food or child care? *
Which of the following government assistance programs do you receive? *
Do you have access to a working washer and dryer? *
Tell us why you are interested in cloth diapering in one sentance. *
Your answer
I have already gone and added cloth4everybum.elpaso@gmail.com to my list of accepted email addresses so that correspondence does not go to my spam/junk folder. *
I understand that if I am accepted into the Cloth for Everybum program, I will have to arrange my own transportation to attend my scheduled Distribution Day, in order to pick up my kit. *
I understand that Cloth for Everybum does not ship kits to local recipients, under any circumstances. *
If accepted into the Cloth for Everybum program, I promise to give cloth diapering a real chance, and do my part to integrate it into my lifestyle. I will contact my mentor if I encounter any problems with the use of my kit. *
How did you hear about our program? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service