Getting to Know You
Please complete the following questions so that we can get to know you better! We will need a separate form for each child in the service.
If any of this information changes, you may email
and we will be sure to update our records!
Child's Last Name
Child's First Name
Parent One - Last Name
Parent One - First Name
Parent Two - Last Name
Parent Two - First Name
Delivery Street Address
Delivery Zip Code
Phone Number (in case we have questions about your order)
Due date (or birth date) of child
don't know yet!
Child's current weight (used for sizing)
not born yet
4 - 10 lbs
6 - 11 lbs.
7 - 15 lbs
15 - 30 lbs
30 - 45 lbs
Would you like to include cloth wipes in your weekly order? (40 wipes for $2 each week.) Please indicate quantity.
Would you like to include rental covers in your weekly order? ($1 per cover per week.) Please indicate quantity.
I will be attending the How to Cloth Diaper with the Diaper Fairy on the following date:
How did you hear about Diaper Fairy?
Word of mouth
I've used the service in the past
Referred by someone (please enter their name below.)
Did someone refer you to The Diaper Fairy? Have a coupon code? Let us know here!
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