Puberty Kit Request Form
These kits are intended for adolescent girls with Down syndrome who are entering puberty or in their first years of puberty. The products in this kit are intended to be samples for use or demonstration of use. If you have a concern about the materials or ingredients in the products (e.g. skin condition or allergy) please indicate in the area provided and alternative accommodations will be made if needed. *Image is an example of products and items may vary slightly
Kits contain samples of various products to assist with changes during puberty and menstruation including pads, personal hygiene wipes, body lotion, body wash, loofah, deodorant, hand sanitizer, lip balm, single-use heating pad. Printed social stories can be used to teach when and how to change different period products, and the postcard lists additional online resources.
Your name (person filling out request)
*
First Name
Last Name
Name of person with Down syndrome who will be using the kit.
*
First Name
Last Name
Age of person with Down syndrome
*
Email (if we should have questions about your form and to send shipping confirmation)
*
example@example.com
Address (at this time, kits are only available to families in West Virginia)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list any allergies or products you prefer to avoid:
Please type the symbols in the box provided
*
Submit
Should be Empty: