Diaper Drive Registration Form
Thank you for hosting a diaper drive! By completing this form, you are helping us plan and meet the needs of families seeking free diapers for their children. If you have any questions or comments, please let us know if the comments section and someone will follow up with you to offer any support you may need.
Company/Group/Organization Name
Contact Name & Title
*
Email Address
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Diaper Drive Start Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Diaper Drive End Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Our diaper collection goal is:
*
1-500 diapers
500-1,000 diapers
1,000-2,500 diapers
2,500-5,000 diapers
5,000+ diapers
Our baby wipes collection goal is:
100-500 wipes
500-1,000 wipes
1,000-2,500 wipes
2,500+ wipes
We are not collecting wipes at this time.
Our monetary contribution goal is:
$100-$500
$500-$1,000
$1,000-$2,500
We are not collecting monetary donations at this time.
How will the diapers get to the Diaper Bank?
*
We will arrange for delivery.
We will need someone to pick up the items.
Anticipated Drop-off/Pick-up Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you hear about us?
Social Media (Facebook, Twitter, Instagram, LinkedIn etc.)
Family/Friend
Employer
Media (Newspaper, Radio, TV, etc.)
Other
Comments or Questions
Would you like to subscribe to receive future emails from the Diaper Bank for Northeast Florida?
Yes
No
Submit
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