Groups – Infant Crisis Services

Group Name*

Type of Group*

Church
Business or Corporation
School
Other

Contact Person*

Email Address*

Phone Number*

Address*

Street Address Address Line 2 City State ZIP Code

1st Requested Date*

2nd Requested Date*

3rd Requested Date

Number of people in group*

Please keep under 20 people.

Our group can bring:*

Infant Crisis Services relies on donations from volunteer groups to keep our babies & toddlers fed and diapered! We appreciate every item that comes through our doors.

Diapers
Wipes
Sippy cups
Diaper rash cream
Other

Group Age*

Adults (18 & older)
Youth (10 - 17 years)

Does your group have any special needs you would like us to accommodate? If so, please explain.

Does your employer have a matching gift program?*

Yes
No

Authorization*

I authorize

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for may prohibit me from volunteering with Infant Crisis Services.

Name

This field is for validation purposes and should be left unchanged.