Cloth Diaper Grant Program Application

To be eligible you must:

Have a child between January 1st and December 31
Be a resident of the City of Clarence-Rockland
Use cloth diapers from birth to potty training
Submit documentation in the first 6 months after the birth
Purchase a minimum of 20 cloth diapers

Applicant Name :

Second Parent Name :

Address

City/Town

State/Province

ZIP/Postal Code

Country

Telephone number :

Email :

Expected Child's Name :

Due Date (MM/DD/YYYY) :

Supporting Documentation Upload (as required) :

One file only.
512 MB limit.
Allowed types: pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif.

Mandatory Supporting Documents:

Proof of residence
Copy of invoice/receipt for the purchase of a minimum of 20 cloth diapers
Copy of birth certificate

I agree to use cloth diapers purchased in conjunction with the City of Clarence-Rockland for the entire period during which my child will wear diapers.

Signing Date :

Applicants Signature :

Sign above

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Cloth Diaper Grant Program Application

Cloth Diaper Grant Program Application