- Use this form as a cover sheet for the Infant/Toddler and Youth profile forms.
- Do NOT use with Bed Application form.
- Fill in completely and please write neatly! Your request will be delayed if we can’t read your writing.
- Request items for ALL CHILDREN IN FAMILY 18 and younger, even if they are not all enrolled in your program.
- Infants must be within 2 months of expected birth date to request items.
- We will notify you if another agency has served the family within the past 3 months.
Guardian Name & Phone Number
- Enter the last name and first initial of the person who has guardianship of the child.
- Guardian phone number is optional, but can be used to help identify the order.
Zip Code & County
These are essential for our tracking. Fill in the zip code and county where the child lives.
Race & Legal Guardian
- Race of child is now listed on the child’s request form.
- Mark the legal guardian with whom the child lives.
- Fill in the TOTAL number of children in the family, even if they are not enrolled in your program(s), and even if you are not requesting items for them all.
- How many children are you requesting items for?
- Have you ever requested items for this family?
- Use this space to list additional items needed by the family that are not on request form. We DO NOT have large furniture, but occasionally have lamps, a few dishes, party/confirmation/sports clothing, etc. Ask! If we have it, we’ll share.
- Any additional information about the family or their situation is helpful for us to fill the request. It also helps us tell our supporters about the families their donations are helping. Personal identities will be protected.
- We assume single parents are usually mothers, however we do have special shirts, books, etc., to celebrate & support dads. Please let us know so we can include those items in their care packages.
DO NOT REQUEST BEDS. Use a Bed Application for that.
Agency & Staff Information
- TIP: Fill out ONLY this area and photocopy the form so you only have to fill out the family info when you put in a request!
- Fill in the name of your agency, and the 4 digit Agency ID number assigned by Hannah’s Treasure Chest. See a list here.
- Fill in the county where your agency is located.
- Going on vacation? Sick leave? Please list contact info for an alternate staff member we can contact to pick up your requests!
- You can also give us the date you’ll be available and we’ll fill your request closer to that date.
- Please fill this out clearly and completely with your full name and the unique 2 digit HTC Staff ID number assigned by your supervisor. DO NOT USE anyone else’s ID number.
- Correct phone number with extension, and your email will help us reach you if there are any errors and when your request is ready.
This area is only for HTC staff to use.
- Mail or bring the form to our office. We do not accept forms via email and we don’t have a fax machine.
- It’s ok to have another staff member bring your forms to us.
- You may submit multiple forms per envelope, if your own program funding allows.
- We appreciate forms being stapled together to help keep them from getting separated.