Apply for cloth diapering loan package

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Please complete this form if you wish to receive a cloth diapering package from Cloth for a Cause

Email *

First Name *

Last Name *

Street address *

City *

Province *

Postal Code *

Phone number *

Please provide name, birthdate, sex, and current weight of each child requiring diapers. If you are expecting a child, please indicate the estimated arrival date of the child. *

What is the biggest financial or other need-based obstacle preventing you from acquiring cloth diapers? *

If you already own cloth diapers, what diapers do you have?

I have read and agree to the terms and conditions set out at https://www.clothforacause.org/termsandconditions.html *

Yes

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