Other Basic Needs

Bedding, bassinets, diapers, pajamas, shoes & socks. *You are now welcome to shop for other clothing and toiletries from our no charge grocery and clothing stores when you pick up your order.

Shelter/Safe House

If you currently live in a shelter or safe house, please list the name and contact info for the shelter/safe house.

Additional Information

Adult #1

Adult #2

Adult #3

Adult #4

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

Demographic Information (optional)

This information is used for funding purposes only! Your answers will not impact the fulling of your order in any way (even if you choose not to complete it). The information gathered may help Project Just Because to receive grants to further benefit those in need. Thank you!
(Please select all that apply)
If you selected "other", please describe how you identify your ethnicity.

Submit

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For security verification, please enter any random two digit number. For example: 83