Truckload of Hope Registration
Families who register but do not show-up twice will be removed from the list of registered families and will not be able to receive diapers. You must bring identification for each child (ex. birth certificate, live birth record from the hospital, military ID, insurance card, passport, Medicaid card, social security card, or other documentation).
The Truckload of Hope is a joint effort of the Diaper Bank of NC and Partnership for Children of Cumberland County, Inc.
Each family who registers and visits the Truckload of Hope will receive FREE disposable diapers and diaper wipes for their children. Children in diaper sizes 5 and smaller will receive 50 diapers per child. Children in diaper size 6 or pull-ups will receive 30 diapers per child. We do not provide diapers for expecting families.
Why are we asking so many questions? To better serve you, make sure we have enough diapers for your children and gather information we need to expand this program to help more families.
The Diaper Bank of NC and Partnership for Children of Cumberland County, Inc. will keep your information private. We will not share your names, address, phone number, email address, or personal information. Data reported to grant funders will not include any names and will only report information about the group (ex. % of military families, etc.).
The Truckload of Hope was created to provide families struggling to afford diapers for their children with free disposable diapers and diaper wipes.
I understand that the goal of the Truckload of Hope is to serve families having difficulty affording diapers on their own.
Each household will receive one supply of diapers and wipes for each child wearing diapers. We cannot provide a supply of diapers to multiple parents, caregivers, or grandparents for the same child.
I understand that I cannot register multiple adults to receive diapers for the same child.
When you visit the Truckload of Hope, please bring identification for each child. Examples include: birth certificate, live birth record from the hospital, military ID, insurance card, passport, Medicaid card, social security card, or other documentation.
I understand I must bring ID for each child to receive diapers.
Families who register twice but do not show-up for the Truckload of Hope will be removed from the list of families to receive diapers.
I understand that after 2 "no-shows" I cannot receive diapers from the Truckload of Hope.
To serve as many children as possible each month, we cannot provide diapers to unborn children.
I understand that if I am pregnant, I cannot receive diapers until my child has been born.
Email (Correo Electrónico)
Phone Number (Teléfono)
Which county do you live in?
Which county do you live in?
How many children in diapers? If you are pregnant, we cannot provide diapers until your child has been born. (# niños que usan pañales)
Please list the names of all children receiving diapers (remember to bring ID for each child):
Please write the ages of all children receiving diapers. (Please write age in months.)
What size diapers do you usually buy for your children? (Please check only one size for each child.)
Pull ups 2T-3T
Pull ups 3T-4T
Pull ups 4T-5T
Relationship to Child(ren)
How many adults are in your household? (¿Cuántos adultos viven en su casa?)
How many adults in your household are currently working outside the home?
How many adults in your household are parenting at home (Stay at home parents who are not working outside the home or looking for other work)?
How many adults in your household are currently looking for work? (¿Cuantos adultos en su hogar están buscando empleo?)
How many adults in your household are students? (¿Cuantos adultos en su hogar están estudiante?)
Are you a military family?
Is a family member currently deployed?
Is anyone in your household eligible for WIC/SNAP/Food Stamps? (¿Alguna persona en su casa califica para el WIC/SNAP?)
Do you ever worry about how you will afford diapers?
Do you ever feel you do not have enough diapers to change your child's diaper as often as you would like?
In the past year, have you had to make a choice between buying diapers and buying something else your family needed? (¿En algún momento durante este último año usted tuvo que elegir entre comprar pañales o comprar otros artículos para su familia?)
The Truckload of Hope was created to provide families struggling to afford diapers for their children with free disposable diapers and diaper wipes. Based on your responses you have shown that you are not experiencing diaper need. Therefore, you are not eligible to receive assistance from the Truckload of Hope.
I acknowledge that I am not eligible to receive assistance from the Truckload of Hope at this time.
Did you have to make a choice between buying diapers and spending money on… (check all that apply) (¿Si la respuesta fue Si, le toco elegir entre comprar pañales o comprar/pagar... Marque todo lo que corresponda)
Rent or Housing (Renta/alquiler)
Utilities (Servicios públicos)
Car Payment (Cuota del carro)
Gas for your vehicle (Gasolina)
Medicine or Healthcare (Medicamentos/algo relacionado con la salud)
Nonfood basic needs like soap, toilet paper, or toothpaste (Artículos de necesidades básicas como jabón, papel higiénico, crema dental)
Receiving diapers will allow my family to: (check all that apply)
La recepción de estos pull-ups/pañales para mi hijo(a) me permite (marque todos los que applican):
take a child to daycare (para llevar a mi hijo(a) a la guardería )
make my child happier (hacer que mi hijo(a) más feliz)
help my child to be healthier (ayudar a mi hijo(a) a ser más saludable)
reduce my stress (reduce es estres)
go to school or job training (para ir a la escuela o capacitación laboral)
go to work (ir al trabajo)
look for work (para buscar trabajo)
buy food (comprar comida)
buy non-food items like toothpaste, soap, or toilet paper (para comprar artículos no alimenticios como jabón)
pay a bill (pagar una factura)
buy clothing (comprar ropa)
Would you like for the Partnership for Children of Cumberland County, Inc to follow up with you about any of the following resources? (Check all that apply)
Car seat program
Help searching for childcare
Help paying for childcare
Child Play Dates
Story & Art Time
Please check if you would like to receive a text message reminder before the event:
Please send me a text reminder
Anything you would like the Diaper Bank of North Carolina or Partnership for Children of Cumberland County, Inc. to know?
Do Not Fill This Out