Donor Application Form

Thank you for supporting disaster relief. Please tell us what you would like to give so we can plan collection and distribution. Donated items should be new or in good, clean condition, and food should be unexpired and sealed.

Full name

First

Last

categories Household items

Organization or business (if any)

Phone

Email

Address 1

Address 2

Parish

Preferred contact method

Tick the categories that apply and note the items and quantity.

Donation categories

Water — items and quantity

Examples: Bottled water, water containers.

Non-perishable food — items and quantity

Examples: Canned goods, rice, flour, crackers, cereal.

Hygiene and sanitary items — items and quantity

Examples: Soap, toothpaste, sanitary pads, diapers, toilet paper.

Clothing and footwear — items and quantity

New or gently used, all sizes.

Bedding — items and quantity

Examples: Sheets, blankets, mattresses, pillows.

Baby supplies — items and quantity

Examples: Formula, baby food, wipes, bottles.

First aid and medical supplies — items and quantity

Examples: First aid kits, bandages, over-the-counter medicines (sealed, in date).

Assistive aids — items and quantity

Examples: Wheelchairs, walkers, canes, crutches, hearing aid batteries.

Cleaning supplies — items and quantity

Examples: Bleach, buckets, mops, garbage bags.

Building and repair materials — items and quantity

Examples: Tarpaulins, zinc, nails, plywood, tools.

Household items — items and quantity

Examples: Flashlights, batteries, lanterns, cooking utensils.

Other — please specify items and quantity

Delivery arrangement

I will drop off my donation
Please arrange pickup

Preferred date

Preferred time

Pickup address (if different from above)

Signature

Date

I confirm these items are my donation, given freely for disaster relief, and may be distributed where the need is greatest.

I agree to the declaration above.

I agree