Gently Used Equipment and Toy Donation Form
Please complete the information below. Once evaluated, a staff member will reach out to confirm if we are or are not able to accept this donation. For multiple items, please complete a new form for each item.
Today's Date
*
-
Month
-
Day
Year
Date
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please select the type of item you're interested in donating.
*
Please Select
Equipment
Toy
What is the item? Please be as specific as possible, i.e., LEGO Classic Brick Set or Medline 12" Wide Kidz Pediatric Wheelchair with Telescoping Handles.
*
Unfortunately, we cannot accept any toys or stuffed animals to that cannot be cleaned daily.
Please rate the condition of the item.
*
Please Select
Fair
Gently-Used
New
Please provide an item description (i.e., what are the item's measurements? Would you qualify the item as small, medium or large? For wheel chairs, please provide the depth and width of the seat.
*
Is the item in good working condition?
*
Yes
No
Is the item missing any pieces or parts?
*
Yes
No
Please upload one or more photos of the item.
Submit
Should be Empty: