Johnson County Diaper Interest TANF Form

Johnson County 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 or email from IDB (link in message). See below for examples of benefits that we will need in order for you to collect your diapers on the date of distribution. Thank you.

Se requerirá prueba de beneficios al momento de registrarse después de recibir el mensaje de texto o correo electrónico del IDB (enlace en el mensaje). Vea a continuación ejemplos de beneficios que necesitaremos para que pueda recoger sus pañales en la fecha de distribución. Gracias.
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