Resource Request Form – Fairfax Church

Welcome! We are so happy you found the Fairfax Church Resource Center. We provide resources to Community Professionals working directly with families who need immediate support. If you are a professional and currently need to obtain resources for a family, we want to support you.

What type of agency do you work for?(Required)

You must work for a nonprofit, school, or government service agency.

Name of school, agency, or organization(Required)

Professional Email Address(Required)

Cell Phone Number(Required)

What is the best way to contact you?(Required)

Client Information

Thank you for all that you do to support the most vulnerable families in our community. PLEASE DO NOT COMBINE REQUESTS ONTO ONE FORM. ONE REQUEST PER FAMILY.

What is the zip code or neighborhood that your client lives in?(Required)

If this is one of several orders you will be submitting for pick up on the same day, is there an identifier that we can use to help separate your donation pick up, (ie, "family initials)?

Family demographic

Tell us about family demographic so we can best assemble resources for them.

How many males ages 11+ are in the family?(Required)

How many females ages 11+ are in the family?(Required)

How many children ages 0 to 36 months are in the family?(Required)

How many children ages 3 to 10 years are in the family?(Required)

How can we assist you today?

Please check most immediate needs that apply.

How many females are in need of feminine products?(Required)

Baby Food

How many children need STAGE 1 baby food (4 to 6 months old)?(Required)

How many children need STAGE 2 baby food (7 to 10 months old)?(Required)

Baby Formula

Please specify other brand of formula

Diapers

How many children are in NEWBORN diapers?(Required)

How many children are in SIZE 1 diapers?(Required)

How many children are in SIZE 2 diapers?(Required)

How many children are in SIZE 3 diapers?(Required)

How many children are in SIZE 4 diapers?(Required)

How many children are in SIZE 5 diapers?(Required)

How many children are in SIZE 6 diapers?(Required)

How many children are in need of pull-ups size 2T-3T (16-34 lbs)?(Required)

How many children are in need of pull-ups size 3T-4T (32-40 lbs)?(Required)

How many children are in need of pull-ups size 4T-5T (38-50 lbs)?(Required)

How many children are in need of pull-ups size 5T-6T (46-60 lbs)?(Required)

How many children are in need of pull-ups size 7T (65 lbs+)?(Required)