Everyday Grace East Community Form-What do you need?

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We serve children in need in Perquimans, Chowan, & surrounding communities with FREE clothing and baby items. Diapers and wipes are sometimes available. We may not have everything you request, but we give generously from what we do have on hand.

Please be specific with what sizes your children need. We will contact you to arrange pick up.

Name *

Contact Information *

Address

Who referred you to us? (Social worker, pastor, ministry, etc) Please provide their contact info.
*

Child

Male

Female

Clear selection

1st Child Name/ description including clothing and shoe size- List what specifically you need

Child 2

Male

Female

Clear selection

2nd Child Name/ description including clothing and shoe size- List what specifically you need

Child 3

Male

Female

Clear selection

3rd Child Name/ description including clothing and shoe size- List what specifically you need

Child 4

Male

Female

Clear selection

4th Child Name/ description including clothing and shoe size- List what specifically you need

Child 5

Male

Female

Clear selection

5th Child Name/ description including clothing and shoe size- List what specifically you need

Other notes or information you would like to share

Option 1

Clear selection

How would you like to receive your items?

I can meet a volunteer at the foster closet in Hertford.

I would like to receive my items through my referral person (social worker, pastor, etc.)

I need to arrange pickup another way.

Clear selection

Submit

Clear form

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