Diaper Request Form
Please fill out the following form and a representative will contact you via phone to arrange pick-up or delivery of needed diapers.
**PLEASE NOTE, WE DO DELIVERIES TO WELCH FOR MCDOWELL COUNTY ONCE EVERY OTHER WEEK - USUALLY FRIDAYS. IF THERE IS AN EMERGENCY AND YOU ARE LOCATED IN THIS AREA, PLEASE TEXT 681-459-0177 FOR ARRANGEMENTS.
19 or Under
20 - 24
25 - 30
31 - 35
36 & Over
Number of Children in Household
Size of Diapers Needed
Pullups - 2T
Have you ever used this Diaper Bank before?
How did you hear about us?
Do you need diapers delivered or picked up?
Delivery (See above note for McDowell county residents)
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