Disinfectant Wipes Needed Form
Please be as explicit and detailed as possible so we can make sure we vet our network of schools to meet both your specific needs and process.

We are a group of educators dedicated to gathering disinfectant wipes to keep our health care workers safe. We will be as responsive as possible (within the day) to provide additional guidance and start preparing lists of schools that can meet your needs.
Hospital Name *
Hospital Address *
Hospital Zip Code *
Name / Point of Contact at Hospital *
Phone Number for Point of Contact *
Email Address for Point of Contact *
Name of Backup Point of Contact
Phone Number of Backup Point of Contact
Number of disinfecting wipes needed(actual number of single wipes as containers differ in size) *
Note that standard small packs come with 35 wipes and large packs come in 75 wipes per pack. Our system will attempt to automatically match as many schools as possible within a specific distance from your Hospital and email both you and the school point of contact with all relevant information to arrange the dropoff.
Drop Off Procedure
Best Time to Drop Off / Exact Location
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy