Diaper Bank Request Form
NEW (FIRST-TIME) CLIENT FORM
We have currently PAUSED new client requests until we go through a re-evaluation period in June 2022 of our funding.
- FIRST-TIME: CLIENT: If this is your first time requesting assistance from our diaper bank — you are on the correct page.
If you are a ...
- RETURNING CLIENT: If you have received assistance from the diaper bank before, please fill out the RETURNING CLIENT form.
- ORGANIZATION REPRESENTATIVE: If you are a representative from an organizations, and wish to make a request on behalf of a client(s), please visit the ORGANIZATION REFERRAL page.
For general information about our diaper bank and what to expect, please see our DIAPER BANK FAQ page.
PLEASE NOTE: Our diaper bank is located in Newbury Park, California, and clients will need to be able to pick up their diapers in Newbury Park or make arrangements for someone to pick up on their behalf.
Eligibility
NOTE: We will NOT process a new client request until we receive the requested documents outlined on our eligibility requirements page.
TO DOWNLOAD ELIGIBILITY REQUIREMENT INFORMATION:
In ENGLISH
In SPANISH
In the email's subject line, please write: "FULL NAME - Eligibility Documents" and send to:
board@conejocommunityoutreach.com.
CONFIDENTIALITY: Under no circumstances is this information intended to be shared with anyone. These will remain confidential and are only for internal verification purposes in order to process your order. We do not require original or certified copies of this paperwork. It is acceptable to take a picture using your phone, and submit the images to us via email.
If the identification you provide does not show your current residency (e.g. a work badge), please also provide a picture of a recent bill addressed to you to confirm residence within County of Ventura. Thanks!
TO DOWNLOAD ELIGIBILITY REQUIREMENT INFORMATION:
In ENGLISH
In SPANISH
In the email's subject line, please write: "FULL NAME - Eligibility Documents" and send to:
board@conejocommunityoutreach.com.
CONFIDENTIALITY: Under no circumstances is this information intended to be shared with anyone. These will remain confidential and are only for internal verification purposes in order to process your order. We do not require original or certified copies of this paperwork. It is acceptable to take a picture using your phone, and submit the images to us via email.
If the identification you provide does not show your current residency (e.g. a work badge), please also provide a picture of a recent bill addressed to you to confirm residence within County of Ventura. Thanks!