Toiletries Request Form

We have moved! Our new address is 850 Vandalia Street Suite 310 & 320, Collinsville, Illinois 62234.

Only select what you truly need. Items limited to stock on hand. Not all items may be available. Shopping assistant will have these items bagged prior to your appointment.

Which volunteer shopping assistant is your appointment with?

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Child's Information

Child's First & Last Name	Child's Date of Birth	Category

Infant

Bottles

Baby Wash

Baby Lotion

Wipes

Toddler

3-1 body wash

Lotion

Ethnic Hair Care smaller children

Ethnic Hair Care Big kid/Teen

To prepare you for what you will be shopping for each child is allowed to select 5 outfits, limit of one brand new outfit, 2 pj's (limit 1 new), 1 pair of shoes, 1 package of underwear, 1 bra (if applicable) 1 package of socks or 6 pairs of black Bombas socks, 1 jacket or coat and one pair of shoes