The Little Timmy Project Support Form - DELIVERY
We will contact you when a delivery is able to go out. *WE ONLY DELIVER WITHIN 465*

Your information is always private. We collect data so we can better support what our community needs.

****IF YOU HAVE SHOPPED OR RECEIVED A DELIVERY IN THE LAST 90 DAYS, please wait to submit another form. We track these and will delete these entries.
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Email *
First Name *
Last Name *
Address -- We will need this in order to drop items off so please make sure that it's correct: *
Zip Code: *
SPECIAL DELIVERY INSTRUCTIONS: please make sure to let our drivers know if there are any gate codes, or special places to leave the delivery (You will receive an email confirming your delivery- we will not call you in advance.)
Phone Number *
Age:
Which of the following best describes you?
Clear selection
Are you pregnant or expecting? *
If you are filling this out for someone else, please make sure to include as much of their information as possible.
Fill out the rest of this form to the best of your knowledge.
If you are pregnant, when are you due?
Please list ages and gender of ALL children. If you do not have any children, please write in "NA". *
Please check any of the programs you are currently enrolled in: *
Required
Items Needed? *Please note, we do not always have the items listed here but will do our best to provide you with what we have in stock!*
Maternity Clothing (check all the sizes you need)
Clothing for Boys (check all sizes you need)
Clothing for Girls (check all sizes you need)
What Diaper Sizes do you need?
Services Needed?
If you are pregnant, would you be interested in a birth doula or postpartum doula? *
Required
Do you have access to transportation? If you do, please go back to sign up for an in shop appointment.
Clear selection
Would you like to tell us your birth story? Please do some here (we maintain all confidential information and will never share your name or personal information with anyone)
What is your first language? We will try to assist with translation services if needed. *
Please list other services/support you need assistance with. We will help as best we can and will try to connect you with resources in your community.
A copy of your responses will be emailed to the address you provided.
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