Care Package Request Form
Thank you for your interest in our programs. We will email you to let you know when your care packages will be ready. Our facility is located at 2623 5th Ave., Unit 102 in Rock Island. We are open on most Thursdays between 4-8pm.

Social workers or approved school personnel are invited to submit a care package request if the child for whom they are submitting the form meets the following criteria:

- Child or young adult who is 20 years-old or younger.

-Currently a foster child.

-Lives in the Quad Cities community in Iowa/Illinois.

Please note that contents of packages are subject to inventory availability.

Registered clients may receive care packages up to 4 times per year. Representatives from social service agencies or schools will need to pick up care packages at our facility within 30 days of the date indicated on their confirmation email or text message.

If you have questions, please call or text 309-235-8786 or email
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Email *
Name or initials
Grade/Year in School
Shoe Size
Please select 1 option for Shirts/Tops:
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Select 1 option for bottom size:
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If available, would you like us to include hygiene items such as deodorant, shampoo, or body wash in the care package?
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If available, does this child need sulfate-free shampoo specialized for natural, curly hair?
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Please list bra size for girls or young women:
Name of person making this referral.
Agency/school affiliation for person making this referral.
We will send you a confirmation notice to let you know when to pick up your care packages. If you would like us to text you, please list your cell phone number, or if you would like us to email your confirmation message, please list your email address.
Comments about child's style, favorite colors, or other information (e.g., if child speaks another language, we may be able to provide books in Spanish, if child has a disability, we may be able to provide accommodating clothing, if a child is a person of color, we may have toys with similar skin tone). This information will help to optimally customize this care package.
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