Request Materials | Maternity Journey

Material Request Form

Full Name (First & Last)

Type & Select Your Address

Email Address

Phone Number

Do you have transportation to pick up materials? Required

yes

If parenting 2 or more, how old is your youngest child? (type NA if not applicable)

What materials are a priority for you & your family? (Check all that apply) Please specify sizes and preferences in box below. Please note we DO NOT distribute diapers to expecting families. Required

Diapers Size 0-6 ONLY (MUST INDICATE SIZE(S))

Wipes

Breast Pump (LIMITED AVAILABILITY. REFERRALS OFFERED)

Other (Specify in box below)

Please Indicate Diaper size(s) needed below (type NA if not applicable) WE DO NOT DISTRIBUTE DIAPERS TO EXPECTING FAMILIES.

PLEASE READ! Share a summary of your journey. Please include details on your current circumstances, like your estimated delivery month, number of children, diaper preferences, other items etc.!

Please Read Carefully

Please understand that all information submitted is confidential.

By completing this form and checking the box below, you agree and understand that all donations/goods received are given under charitable intentions. The Donor shall in no event be liable for any claim whatsoever by the recipient, or any third party, for any issue involving the goods or the condition of the goods received. You agree and understand that donations are given based on supply and although we do our best to provide the material requested, there is no guarantee rendered for the request submitted. You will be notified via phone/email in regard to the status of your submission, should the Donor receive no response from the recipient to complete this request, the recipient's submission can be subject to rejection at the Donor's discretion.

I understand and accept terms & confirm that the information submitted is true.