Cloth/Homemade Mask Form
Thank you for supporting Children's National Hospital during this urgent time! We are grateful for the collective strength of our community to meet the unprecedented needs of our patients, families and care providers. Following the CDC’s recommendation that the public wear cloth face coverings in public settings, Children’s National Hospital is accepting cloth/homemade masks from the community. If you plan to donate cloth masks, please complete the form below. The fabric used must be breathable, washable, latex-free and non-carcinogenic. We will accept both child and adult size masks; please label the sizes on the final product before shipping or delivering.
Name
*
First Name
Last Name
Company/Organization Name (if applicable)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
How many masks are you be able to provide?
*
Estimated Value of the Item(s)
What is the delivery/shipping method?
Deliver to CN Main Campus
Ship to CN Main Campus
Have you already delivered or shipped these items?
Yes
No
If applicable, please provide the tracking number for the shipment:
If you have been in touch with a Children's National employee about this donation, please include their name here:
Additional Information/Comments
Please sign electronically to confirm your contribution:
Submit
Should be Empty: