Request Child Items Form
Please fill out 1 per infant/child. When choosing sizes, please note that items usually take more than one month to arrive.
Submitting a request does not guarantee you will receive your request, but we will do our best.  
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Email *
First Name *
Last Name *
Contact Number for delivery *
Delivery Address *
Who referred you to this form? *
Items Needed
Please fill out 1 form per infant/child in need of assistance.
Is child clothing needed? Please include gender and sizes. (i.e. girls sizes 5T, mx of baby clothes 12m,etc.)
Are you in need of a car seat? If yes, please select which kind.
Clear selection
Is your child in need of diapers? Please select a size.
Clear selection
Does your child need any of the follow items?
Does your child need formula? If yes, what brand?
Would you like any of the following comfort items?
Children's toiletry items needed
Other items needed
Is there anything else needed that wasn't listed above?
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