Diaper Bank Partner Application
Agency Name:
Street Address:
City:
Zip Code:
Phone:
Website:
Mission Statement:
Primary Contact:
Primary Contact Position:
Primary Contact Phone:
Primary Contact Email:
Executive Director:
Are you are a registered 501(c)3?
Select ...
yes
no
pending
Other
Please check all that apply to your past history with the Junior League of Lawton:
Placement (recurring volunteers)
Project (volunteers + funding)
Done-in-a-Day (one time volunteers)
Other
Please check all that apply to your intended status with the Junior League of Lawton:
Placement (long term volunteers)
Project (long term volunteers + funding)
Done-in-a-Day (one time volunteers)
JLL Diaper Bank Assistance
Please provide a copy of your insurance certificate:
Diaper Size Preferences:
Premature
Newborn
Size 1
Size 2
Size 3
Size 4
Size 5
Size 6
Size 7
2T/3T Pull-Up
3T/4T Pull-Up
4T/5T Pull-Up
Swim Diapers
The recipient agency certifies that it is a nonprofit 501(c)(3) social service agency, a religious organization, or other governmental agency, providing social services to individuals or families in need. All diapers provided by JLL Diaper Bank must be given to clients of the recipient agency at no cost to the client. The recipient agency may not sell, trade, or barter items obtained from the JLL Diaper Bank, nor may those items be used for fundraising, auctions, or raffles. JLL Diaper Bank makes no guarantees or warranties with regard to safety or quality of any items provided to the recipient agency. JLL Diaper Bank receives donated items that have not been inspected for safety or quality. JLL Diaper Bank is providing items to the recipient at no cost. It is the responsibility of the recipient agency to inspect the items before providing items to clients. By accepting items from JLL Diaper Bank, the recipient agrees to release the JLL Diaper Bank, its administrating agency, its officers, and volunteers from any liability and agree to hold them harmless against all liabilities, damages, losses, claims, causes of action, and suits of law or equity or obligation whatsoever arising out of or attributed to any actions from the distribution of items or the use of the items provided by JLL Diaper Bank To help us estimate need, the recipient agency will complete a monthly order form before receiving an item distribution. The recipient agency will collect information requested by JLL Diaper Bank from clients receiving items to aid JLL Diaper Bank in qualifying for grants and funding. However, JLL Diaper Bank will never request information that will lead to the identity of clients receiving items from the recipient agency. The recipient agency will not discriminate on the basis of race, color, national origin, gender, religion, age, ability, political beliefs, sexual orientation, or marital or family status. Further, the agency will not require attendance at religious services as a condition of assistance in any of the programs that distribute diapers, nor will any client be exposed to religious proselytizing of any type. JLL Diaper Bank reserves the right to remove the recipient agency from its distribution list at any time in the sole discretion of JLL Diaper Bank. If any portion of these terms and conditions are violated by the recipient, JLL Diaper Bank will no longer distribute items to the recipient agency. The recipient agrees it shall not hold itself out or in any way represent that recipient is an employee or agent of JLL Diaper Bank. Nothing herein shall be construed as creating an employer/employee relationship between the parties. JLL Diaper Bank may publish the name of each recipient agency on our website, social posts, and other public relations media promoting Junior League of Lawton and JLL Diaper Bank. The recipient understands that JLL Diaper Bank has limited inventory of items. JLL Diaper Bank will make every effort to meet the recipient’s diaper needs as requested but is not accountable to do so. If the recipient agency is no longer distributing items provided by JLL Diaper Bank or no longer needs to receive items from JLL Diaper Bank, the recipient agency must notify JLL Diaper Bank in writing of such immediately.
You are not currently logged in. Please log in to submit this form.
Cancel
