Request Items

parents helping their daughter to get ready for school

Safe Haven Foster Shoppe is pleased to help fulfill the needs of children in foster care. Foster Parents or Social services workers can call, email, text or complete the following form to request items at any time of day. If you have more than one child you are requesting items for, please complete a new request form for each child. Please note our program is intended for initial placements.

Name

Request Relationship

Phone

County or Agency (Licensed with)

Date of Placement

Are you picking up the items or requesting delivery?

Delivery Address (if requested)

Child

Boy Girl

Age

Clothing Size & Shoe Size (if requested)

This child needs...

Placement Bag Additional Clothing Shoes Winter Coat

Other details about the Child (Special needs, Interests, etc. Or other Items Needed (Shoes, outerwear, school supplies, formula, etc)

How did you hear are us?

I have more than 1 child in need of items. If you have multiple children to request items for, please submit and complete the form again.

Yes - I will submit another form. No

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