2023 Winter Clothing Request Form

2023 Winter 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!
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* IMPORTANT CHANGES *

Due to changes in our operations, we are restructuring our request process to better serve you. Moving forward, you will be able to request clothing once every 4 months!
Would you like to receive a fall or winter clothing pack?

Please read the following and check that you understand how our program works:*
I am a*

Primary caregiver; a parent, legal guardian, or kinship caregiver.Social worker, teacher, counselor, resource coordinator or other professional.Family member, friend or other individual completing this form on behalf of a family.
Select the answer that best applies.*

I have received clothing from Give Like a Mother before.This is my first time completing a clothing request.
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.
Contact Us

Call: 513-732-0130

Call or Text: 513-400-3208

Email: contact@givelikeamother.com

For the purposes of this form, the parent or legal guardian is referred to as the primary caregiver.
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 the primary caregiver'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.

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 Clermont County residents.
Please read and check the following:*

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)

Be sure to check your email and texts for our message when your pack(s) are complete! Thanks!
I understand that I will not receive winter clothing until after October 15th.

I understand
Should be Empty:

Please provide your contact information below.