Care Package Request Form

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Thank you for your interest in our programs. When possible, we invite children who meet the criteria listed below to shop with us in person at our facility (2623 5th Ave., Unit 102 in Rock Island) on Thursdays between 4-8 pm. For children who have transportation or other barriers, a custom care package may be requested.

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

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

-Currently a foster child or a child who is experiencing homelessness.

-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 they are requested. You will be emailed pick up dates/times after your order is processed.

If you have questions, please call or text 309-235-8786 or email info@closet2closet.org

Email *

INFORMATION ABOUT THE CHILD WHO WILL RECEIVE THE CARE PACKAGE

Name or initials

Age

Grade/Year in School

Gender

Name of School

Shoe Size

Please select 1 option for Shirts/Tops:

Adult women's/juniors size EXTRA SMALL (0-3)

Adult women's/juniors size SMALL (4-6)

Adult women's/juniors size MEDIUM (7-9)

Adult women's/juniors size LARGE (10-12)

Adult women's/juniors size EXTRA LARGE (13-16)

Adult women's/juniors size XXL (17-20)

Adult men's/juniors size SMALL

Adult men's/juniors size MEDIUM

Adult men's/juniors size LARGE

Adult men's/juniors size EXTRA LARGE

Adult men's/juniors size XXL

Girl's/youth size SMALL (5-6)

Girl's/youth size MEDIUM (7-8)

Girl's/youth size LARGE (10-12)

Girl's/youth size XL (14-16)

Girl's/youth size XXL (18-20)

Boy's/youth size SMALL (5-6)

Boy's/youth size MEDIUM (7-8)

Boy's/youth size LARGE (10-12)

Boy's/youth size XL (14-16)

Boy's/youth size XXL (18-20)

Other:

Clear selection

Select 1 option for bottom size:

Adult women's/juniors size EXTRA SMALL (0-3)

Adult women's/juniors size SMALL (4-6)

Adult women's/juniors size MEDIUM (7-9)

Adult women's/juniors size LARGE (10-12)

Adult women's/juniors size EXTRA LARGE (13-16)

Adult women's/juniors size XXL (17-20)

Adult men's/juniors size SMALL (waist size 28 or 30)

Adult men's/juniors size MEDIUM (waist size 32 or 34)

Adult men's/juniors size LARGE (waist size 36 or 38)

Adult men's/juniors size EXTRA LARGE (waist size 40 or 42)

Adult men's/juniors size XXL (waist size 44 or 46)

Girl's/youth size SMALL (5-6)

Girl's/youth size MEDIUM (7-8)

Girl's/youth size LARGE (10-12)

Girl's/youth size XL (14-16)

Girl's/youth size XXL (18-20)

Boy's/youth size SMALL (5-6)

Boy's/youth size MEDIUM (7-8)

Boy's/youth size LARGE (10-12)

Boy's/youth size XL (14-16)

Boy's/youth size XXL (18-20)

Other:

Clear selection

If available, would you like us to include hygiene items such as deodorant, shampoo, or body wash in the care package?

Yes

Clear selection

If available, does this child need sulfate-free shampoo specialized for natural, curly hair?

Yes

Clear selection

Please list bra size for girls or young women:

INFORMATION ABOUT THE PERSON SUBMITTING THE FORM

Name of person making this referral.

Agency/school affiliation for person making this referral.

Phone number of person making this referral.

Comments about child's style, favorite colors, or other information to help us optimally customize this care package:

Submit

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