Cass Co. Diaper Interest TANF Form

Cass Co. Diaper Interest TANF Form

This form is for showing interest, and does not guarantee diapers.
Information for Interest

Communication has changed and WIC offices are no longer allowed to send out text messages. Please fill out this form to allow us to contact you with sign-up information. Sign-up will continue to be first come first serve. Please know this does not guarantee you a spot.

Please do not contact the local WIC office with any questions. For any questions, please contact us via email at indianadiaperbankserviceproject@indianadiaperbank.org.

If you do not show up for your pickup slot after 2 times of signing up, Indiana Diaper Bank reserves the right to delete your submission.
Name*

First NameLast Name
Email*
example@example.com
Number of Children in diapers *
Phone Number*
Please enter a valid phone number for text messages.
I understand that this form does not guarantee that I receive diapers. I will get a text message from Indiana Diaper Bank with a sign-up link in the future. *
Signature- Show you understand the information above. *

Clear
**Please Read Below**
Proof of benefits will be required at time of sign-up after you receive the text message from IDB (blue link in message). See below for examples of benefits that we will need for you to collect your diapers on the date of distribution. Thank you!
Should be Empty: