Village Center Clothing Request Form

Village Center Clothing Request Form

Share your current clothing needs so staff can review them before your visit—inventory changes, so specific items and sizes can’t be guaranteed.
Caregiver Information
Caregiver Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method

Other
Referral / Agency Information
Agency or Organization
Caseworker / Support Worker Name
Family Type and Placement Details
Family type

Other
Is this for a new or emergency placement?
Placement date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child Clothing Needs
Use the section below to add clothing needs for each child in the household. Add one row per child.
Child 1 Clothing Needs
How soon do you need these items?
Acknowledgments
Acknowledgment of donation and availability limits
Acknowledgment to request only needed items
Acknowledgment that availability is not guaranteed for all items or sizes
Consent to be contacted about this request
Acknowledgment of information use for support and program documentation
Are you available to pick up your items at the Village Center (901 Beauty Ave., Bowling Green, KY) Monday-Friday 9AM-2PM?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you are unable to pick up during these hours, our team will contact you. Delivery is available in most circumstances but cannot be guaranteed.
Should be Empty: