Request a Care Pack
Be the Village supports new foster, kinship, relative, and reunifying placements with Care Packs that include clothing, shoes, toiletries, and age and gender-specific comfort items. To be eligible for a Care Pack or supplies, youth must be within their first month of placement into foster care or their first three months of placement into a kinship or fictive kin placement, or must be actively reunifying after being placed in Out of Home Care.
Caregiver Name
*
First Name
Last Name
Spouse/ Partner's Name
Phone Number
*
Please enter a valid phone number.
Do you prefer to be contacted by phone call or text?
Please Select
Phone Call
Text Message
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who is filling out this form?
*
Please Select
Caregiver
Social Worker
Name of Assigned Caseworker & Agency
*
Only DCBS & PCC Caseworkers are able to make requests
Caseworker Phone Number
Please provide if Caseworker is making the request.
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Which best describes this family?
*
Please Select
Foster Family
Kinship/ Fictive Kin Placement
Reunifying Family
Which of these qualifies this family for Care Packs or supplies?
*
Please Select
Child was placed into foster care within the past month
Child was placed into kinship or fictive kin care within the past three months
Child is actively reunifying after being in Out of Home Care
This family does not meet any of this criteria and is not currently eligible for this program
How many children need supplies?
*
Please Select
One
Two
Three
Four
Five
Child #1 Info
Date of Placement
*
Gender
*
Please Select
Female
Male
Age
*
Clothing Size (Please specify shirt and pants size)
*
Shoe Size
Race for Haircare Products
Does child need formula or diapers?
*
Please Select
Yes
No
Diaper/ Pull Up Size
Formula Type
Tell us anything about child's interests and favorites. Please include style preferences for teens if known. Provide any other necessary info here too.
*
Child # 2 Info
Date of Placement
*
Gender
*
Please Select
Female
Male
Age
*
Clothing Size (Please specify shirt and pants size)
*
Shoe Size
Race for Haircare Products
Does child need formula or diapers?
*
Please Select
Yes
No
Diaper/ Pull Up Size
Formula Type
Tell us anything about child's interests and favorites. Please include style preferences for teens if known. Provide any other necessary info here too.
*
Child #3 Info
Date of Placement
*
Gender
*
Please Select
Female
Male
Age
*
Clothing Size- Please specify if this is an adult or child size. Provide both shirt and pants size.
*
Shoe Size
Race for Haircare Products
Does child need formula or diapers?
*
Please Select
Yes
No
Diaper/ Pull Up Size
Formula Type
Tell us anything about child's interests and favorites. Please include style preferences for teens if known. Provide any other necessary info here too.
*
Child #4 Info
Date of Placement
*
Gender
*
Please Select
Female
Male
Age
*
Clothing Size (Please specify shirt and pants size)
*
Shoe Size
Race for Haircare Products
Does child need formula or diapers?
*
Please Select
Yes
No
Diaper/ Pull Up Size
Formula Type
Tell us anything about child's interests and favorites. Please include style preferences for teens if known. Provide any other necessary info here too.
*
Child #5 Info
Date of Placement
*
Gender
*
Please Select
Female
Male
Age
*
Clothing Size (Please specify shirt and pants size)
*
Shoe Size
Race for Haircare Products
Does child need formula or diapers?
*
Please Select
Yes
No
Diaper/ Pull Up Size
Formula Type
Tell us anything about child's interests and favorites. Please include style preferences for teens if known. Provide any other necessary info here too.
*
Back
Next
Please Check All Needed Items
*
Clothing
Twin Bed & Mattress
Toddler Bed & Mattress
Crib & Mattress
Bassinet
Bedding (Only provided with beds)
Backless Booster Carseat (6 years+)
High-back Booster Carseat (5-6 years)
Harness Booster Carseat (3-5 years)
Convertible Carseat (6 months-3 years)
Infant Carseat (NB- 9 months)
Backpack with School Supplies
Diapers/ Pull Ups
Formula
Diaper Bag
Baby Bottles
Stroller
Swing/ Infant Bouncer
High Chair
Other (Please Specify Below)
Needs
Please note: we fill requests based on current stock and can't guarantee that a need will be met. If more than one of an item is needed (ex: two convertible car seats for two different children) please specify in the Other Needs Section below.
Other Needs: Please list any needs not specified above.
I understand that all items provided are for the placements they are given to. I commit to send the items with the child if/when they leave my home. I understand that this includes beds and carseats.
*
Please Select
I agree with these terms
Will these items be picked up at the Resource Center or delivered to DCBS?
*
Please Select
Pick Up at Resource Center
Deliver to Pulaski DCBS (Pulaski DCBS Workers Only)
Deliver to Laurel DCBS (London DCBS Workers Only)
Who is picking up the supplies?
*
Please Select
Caregiver
Social Worker
Family Member or Friend
Delivery to DCBS
Proof of placement is required for all Care Packs and Supplies. If you have that information available, please upload it now.
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