2023 Spring-Summer Clothing Request Form

2023 Spring-Summer Clothing Request Form

At Give Like a Mother we understand that sometimes it takes a village to raise a family. We are happy that you reached out and that we are able to help! Please contact us at contact@givelikeamother.com or call 513-732-0130 if you have any questions.
Para completar este formulario en Español, haga clic AQUÍ.
Please read the following and check that you understand how our program works:*
Give Like a Mother is committed to ensuring the privacy of individuals and families who request our help. The information you provide will be kept confidential and will not prevent you from receiving assistance.*

I understand.
I am a*

Primary caregiver; a parent, legal guardian, or kinship caregiver.Social worker, counselor, resource coordinator or other professional.Family member, friend or other individual completing this form on behalf of a family.

Please provide your contact information below.

You will fill out the family's information in the next section.
Please select the answer that best describes you.*

I am completing this form in the presence of a primary caregiver. They will be able to provide a signature to attest the following information is true to the best of their knowledge.I am completing this form on behalf of a primary caregiver who is not present. I am unable to provide a parent/guardian's signature at this time.
Your Name *

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Will you be picking up on behalf of the family you are making a request for?*

Yes.No.I'm unsure.
For the purposes of this request form, the primary caregiver is referred to as the applicant. The next section will ask you to provide the applicant's information. Please list the primary caregiver's information. DO NOT PROVIDE YOUR PERSONAL INFORMATION IN THE FOLLOWING SECTION.

Sizing and Gender

Please take care in selecting the correct sizes for the child.
Child's Gender*

MaleFemalePrefers female clothing but is male at birth (will receive girls/women's clothing)Prefers male clothing but is female at birth (will receive boys/men's clothing)
Does this child wear INFANT, TODDLER, YOUTH or ADULT sizes?*

Infant (Newborn to 24 months)Toddler (2T to 5T)Youth (6-7 to 18-20)Adult (XS - 6XL)

Pick Up Availability

We will contact you when your clothing items are ready for pickup. Please follow the instructions for scheduling a pick up time included in that correspondence.
Are you (or someone that you choose) able to pick up your clothing pack(s) from our facility in Batavia, Ohio?*

YesNo

Please ensure a completed copy of this form is returned to Give Like a Mother.

Please print this document and have the primary caregiver complete it. Only one copy is required for each family. This form only applies to CLERMONY COUNTY residents.

Please check that you understand the following:*

	I understand.
I understand I am responsible for returning a completed copy of this form to a Give Like a Mother representative.

Be sure to check your email and texts for our message when your pack(s) are complete! Thanks!
Should be Empty:

Please provide your contact information below.