The Diaper Drawer - Request for Assistance

1

Have you received support from The Diaper Drawer within the past 30 days?* This field is required.

YESNO

2

We see that you have received assistance from The Diaper Drawer within the past 30 days.

Our regular assistance is limited to one 10-day supply per household every 30 days. The Diaper Drawer is intended to provide short-term emergency support and is not intended to replace a household’s regular monthly supply.

If you are experiencing an exceptional or urgent circumstance, you may continue with this request and tell us more about your situation in the notes section. Additional assistance is considered on a case-by-case basis and depends on available inventory.

3

Name* This field is required.

First Name

Last Name

4

What community do you currently live in?* This field is required.The Diaper Drawer is based in Lacombe and primarily supports Lacombe and surrounding communities. Requests outside our usual service area may be considered depending on available supplies and circumstances

Lacombe

Lacombe County

Clive

Bentley

Blackfalds

Ponoka

Red Deer

Other

5

Requests submitted before 7PM will be available the next day * This field is required.If packing orders is delayed, we will post an update to our Facebook and Instagram page. Do you understand?

YESNO

6

Phone Number

Please enter a valid phone number.

7

Are you able to pickup in Lacombe?* This field is required.We currently offer porch pick-up in Lacombe, we have some volunteers who *MAY* be able to deliver within Blackfalds and Red Deer

Yes

I need to discuss delivery options

8

Delivery Address* This field is required.Please provide the address where you would need your items delivered. This information will only be used to coordinate delivery

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

9

Can you pick up your package within 24 hours?* This field is required.Requests submitted before 7 PM will generally be available the following day. Once you receive your package number, please arrange pickup as soon as possible. Packages must be picked up within 24 hours due to limited storage space.

YESNO

10

Preferred way to be contacted* This field is required.

Email

Other

11

Facebook Name***If you would prefer to be contacted via Facebook Messenger please send us a message @ The Diaper Drawer - Lacombe to let us know you’ve submitted a request. ***

If incomplete, we will be unable to complete your request

12

Email* This field is required.We will email you a confirmation of your package number and pick-up instructions. Please watch for an email from thediaperdrawer.lacombe@gmail.com

example@example.com

13

What are you requesting?* This field is required.Please select all that apply.

Post-Partum Supplies

Menstrual Supplies

Diapers/Pull-ups

Wipes

Other

14

How many children are you requesting for?* This field is required.This helps us determine the amount of supplies we can provide with your request.

15

Children's Needs* This field is required.Please list only children who are part of your household or are currently in your care. Requests are limited to one per household every 30 days, regardless of who submits the application. Submitting multiple requests to bypass these limits, providing misleading information may result in suspension or permanent ban from accessing The Diaper Drawer.

16

What size(s) do you need?**Please include the sizes needed for all items you are requesting to simplify the process**.

17

Approximately how many days are you needing help covering?* This field is required.Please remember this is to fill in the gaps, we don’t currently have the ability to provide a regular monthly supply ❤️

1-2 days

3-4 days

5-7 days

Other

18

Is there anything else you’re currently short on?The Diaper Drawer is starting small, but we’d love to know what other essentials would be helpful for your family. This doesn’t mean we can provide everything listed, but your answers will help us understand what our community needs

Diaper Cream

Formula

Overnight Diapers

Other

19

What type or brand of Formula do you need?* This field is required. Formula donations are limited, and we cannot guarantee availability. We will do our best to accommodate your request if formula is available in our inventory.

20

Menstrual SuppliesPlease select the supplies that you are in need of. We will to do our bed to accommodate your request based on our inventory.

22

Are there any diaper or wipe brands that your child reacts to or you need to avoid?Please list any brands that cause allergic reactions. Please note, that limiting the brands you are able to use may result in us not being able to donate to you. This is not for diaper preferences.

23

Failing to send us a message or email will result in your order not being filled. * This field is required.Do you understand?

YESNO

24

Is there anything else that you would like us to know?

25

A Quick Note ❤️

The Diaper Drawer provides donated products to help support families in our community. While we do our best to provide products that are safe, appropriate, and in good condition, we cannot guarantee that every product will be suitable for every individual.

Please check all products before use and follow the manufacturer’s instructions, age/size recommendations, and safety guidelines. If your child or anyone in your household has an allergy, sensitivity, medical condition, or other concern, please use your own judgment and consult a healthcare professional when appropriate.

The Diaper Drawer, its volunteers, donors, and community partners are not responsible for any allergic reactions, sensitivities, injuries, damages, or other adverse effects resulting from the use of donated products.

By accepting donated items, you acknowledge that you are responsible for determining whether a product is appropriate and safe for your family.