COVID-19 - Infant Supplies

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This form is for families needing infant supplies during COVID-19. Products will be distributed through contact free delivery to those in need.

Please fill out the following information so we can ensure we are providing support in the best possible way.

Name: *

Phone Number:

Email:

Address: *

How do you identify? *

First Nations

Inuit

Métis

Non-Indigenous

Do you face any barriers to accessing infant supplies (being able to purchase products, able to go to a store)? If so, please explain. *

Number of infants in household: *

Please let us know which hygiene products you are currently in need of: *

Formula

Baby food

Diapers

Wipes

Diaper cream

Baby wash

Infant tylenol

Breast pads

Other:

Required

If you are requesting diapers, please let us know which size(s) are needed:

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