Lincoln Hygiene Bank Registration and Order Form

Lincoln Hygiene Bank
Lincoln Hygiene Bank - Pack Request
Lincoln Hygiene Bank - Registration
Are you:*

RegisteringRequesting Hygiene PackRegister & Requesting Hygiene Pack
Please note: We can only supply hygiene items ONCE PER MONTH per registered name
Date*

DayMonthYear
Date
Location for collection*
Other Location details
Name (Please use capitals)*

First NameLast Name
Phone Number*

Area CodePhone Number
Email (Please use capitals)
example@example.com
Reason for need?*
Ethnicity (Optional)
Religion (Optional)
Number of FEMALEs that need hygiene products?*
Number of CHILDREN that need hygiene products?*
Number of MALEs that need hygiene products?*
Date Signed*

DayMonthYear
Date
Signature*

Clear
We do accept money donations to help increase our stocks, either in cash or card (if you know anyone able to help in this way)
We understand that you care about your privacy, and we take this responsibility seriously. The Centre for Reconcoiliation will respect and treat your personal information with the due care that you have entrusted us. We promise to take all reasonable steps to keep your details secure be ensuring appropiate technical and organisation al measures are in place to safeguard your information.

For more information, email enquiries?tcf-reconciliation.org
Lincoln Hygiene Bank - Pack Request Form
Name (Please use capitals)*

First NameLast Name
Date

DayMonthYear
Date
For Women (Max 7 Items)

Period ProductsShampoo & ConditionerHair Styling ProductsFace WashCleanser & CreamsBody WashBody LotionDeodorantsToothpasteTooth BrushDisposable Razors
For Men (Max 5 items)

Shampoo & ConditionerShower GelsDeodorantDisposable Razors & Shaving FoamToothpasteTooth BrushHair Styling Products
For Babies & Children (Max 6 Items)

Nappies & Pull-Ups - SIZE?Night-Time pants for older ChildrenBaby WipesBarrier CreamToothpasteTooth brushBaby WashBaby & Kids ShampooNit Comb
Household (Max 4 Items)

Laundry DetergentHousehold cleaning ItemsToilet RoillsTissuesCleaning Wipes
Should be Empty:

Lincoln Hygiene Bank

Lincoln Hygiene Bank - Pack Request

Lincoln Hygiene Bank - Registration