RLA Donations Form

First Name *

Last Name *

Email Address *

Contact Number *

Who is the best person to contact you about this form? *

Support FacilitatorSupport CoordinatorContact me directly

Who is filling out this form? *

Participant's Name (if relevant)

Support Facilitator or Support Coordinator Name *

Support Coordinator Contact Number

Support Coordinator Email Address

Are you looking to donate and/or receive a donation? *

I wish to donate an itemI am looking for an item

What item(s) do you wish to donate? For multiple items, please add a new row for each item

We do not accept the following items:

Mattresses Clothes Heaters

Stuffed Toys Baby Seats Dryers

Glass-Topped Tables

Item category *

Description *

Measurements

Please Attach Photos *

Browse

Full pick up Address *

Delivery Address

Other relevant information

Pick up deadline

What kind of item are you looking for? *

Any further details or measurements? *

Full Delivery Address *

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