OCRC Diaper Order Form

Orcas Community Resource Center is excited to introduce our Diaper Bank program. Through a generous grant from the Department of Commerce, families meeting eligibility criteria and having children under the age of 3 can apply to receive a monthly allotment of diapers, wipes and ointment without cost.

WE WILL CONTACT YOU WHEN YOUR ORDER IS READY FOR PICK UP!

*Pick up at Orcas Community Resource Center
374 North Beach Rd
Eastsound, WA 98245
Open M/W/F 9am-4pm and T/Th 10am-4pm

Questions? Contact 360-376-3184 or info@orcascrc.org

Parents' / Guardians' Name(s)*

Parent Phone*

Parent Email*

Are you currently receiving any public assistance?

If "Other Public Assistance" selected, please indicate assistance.

Child #1 Name *

Child #1 Date of Birth*

Child #1 Diaper Size*

Child #2 Name

Child #2 Date of Birth

Child #2 Diaper Size

Child #3 Name

Child #3 Date of Birth

Child #3 Diaper Size

Would you like wipes?

YESNO

Would you like baby ointment?

YESNO

Please include any additional notes.

By submitting this request, you agree to use products for your personal family use and will not sell or gift to others.