We Have Diapers! Size 5 & Size 6
We will be delivering until we run out! MALO continues to be blessed with amazing community partners! Like Reach Out and First 5. We have diapers! Please fill out the information below so we can organize routes for pick up or distribution in San Bernardino County to Riverside County until we run out. Delivery will be from 9-12 and will be contactless drop off.
Sign in to Google to save your progress. Learn more
Email *
First Name:
Last Name:
Address: Street # and Street Name
Address: City
Address: Zip Code
Address: If apartment/Gated Home: Gate Code*leave instructions in comments and concerns section on how to enter to apartment or gated home area.
Phone Number:
Preferred way of contact:
Clear selection
What size diapers:
Clear selection
How many packs: (packs come 40 per pack)
Clear selection
What size diapers:
Clear selection
How many packs: (packs come 40 per pack)
Clear selection
How many children to do you have? ( This information can help us connect resources quickly)
Clear selection
What are the ages of your children (please list Male/Female and age)
How many elders ages 50 and up live with you? ( This information can help us connect resources quickly)
Clear selection
Please list how many Male/Females:
Did you receive your vaccine, booster, flu shot today?
Clear selection
Would you like to be added to our Food and/or Resource distribution list?
Clear selection
How many in your family will attend? We would like to provide a hotdog, chips, and a drink on the way out of the event.
Please share resources we should be looking for that can help in your day to day:
MALO is happy to serve! Please share any questions, comments, or concerns below:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy