Hope Room items for children and youth we serve
Possible new items depending on funding: car seats, bedding, diapers, clothes, shoes. Please ask for other items and we will fulfill your need, if possible.
Caregiver Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Social Worker's Name and Office (or N/A)
*
Name of foster/ adopt Child
*
First Name
Child's relationship to Caregiver
*
Please Select
Traditional Foster
Adopted
Guardianship
Kinship (relative)
Other
If "Other", please describe
Age
*
Gender
*
boy or girl
Name of 2nd foster/adopt Child
First Name
Age
Gender
boy or girl
Name of 3rd foster/adopt Child
First Name
Age
Gender
boy or girl
Please be specific in telling us what you need in clothing or furniture for each child. Tell us the sizes, gender, and shoe sizes.
*
Foster/adopt child # 1
If requesting a car seat, please give weight of child and whether car seat needed is forward or rear facing.
Foster/adopt child #2
Foster/adopt child #3
Our office is usually open Monday - Thursday from 10 am to 3 pm in Lewiston. To pick up items, indicate here when you are available during our office hours.
We may be able to ship items directly to you. Please write delivery location: a physical home address, or social worker's office. If a home address, shipping will occur from the merchant where we purchase your items.
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