Check the below box to confirm the location you are submitting this form.
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Yes, I understand I am picking up our requests at:
Johnson City:
Heritage Baptist Church
1512 John Exum Pkwy
Other Agencies
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If other was selected above please fill out your agency here, If not applicable please put N/A.
The name of the person filling out this form:
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This is for the name of the person that will be contacted when the items are ready for pickup and if there are questions regarding the request.
First Name
Last Name
Phone number of the person filling out this form:
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Please provide a personal number so we can contact you regarding questions or item fulfillment.
(###)
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My DCS Agent's Name Is
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Please provide the name of your DCS Agent and/or local affiliate.
If you have guardianship/custody court paperwork and no caseworker, enter your own information in these boxes and PLEASE EMAIL US at info@smilefostercloset.org with copies/photos of those documents attached to the email. Your request will not be processed until we receive this information.
First Name
Last Name
DCS Agent's Contact Number
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(###)
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My DCS Agent's Email is
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I Am In Need Of...
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Please check all that apply.
Urgency of Request
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Please let us know how quickly we need to provide your items. If you need your items ASAP you must fill out the Kingsport request form and pickup your items from our main closet in Kingsport. You may do that by copying and pasting the link below:
https://smilefostercloset.org/request-form-1
Season Preference
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Please let us know which season of clothing preferred
Child 1
Please list the following information for child 1.
Age
Shirt Size
Pant Size
Underwear/Diaper Size
Bra Size (if applicable)
Sock Size
Shoe Size
If the child is in adult sized clothing please specify that they need Mens or Misses items next to the size.
Age of Child 1
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Gender of Child 1
Special Requests
Child 2
Please list the following information for child 2.
Age
Shirt Size
Pant Size
Underwear/Diaper Size
Bra Size (if applicable)
Sock Size
Shoe Size
If the child is in adult sized clothing please specify that they need Mens or Misses items next to the size.
Age of Child 2
Gender of Child 2
Special Requests
Child 3
Please list the following information for child 3.
Age
Shirt Size
Pant Size
Underwear/Diaper Size
Bra Size (if applicable)
Sock Size
Shoe Size
If the child is in adult sized clothing please specify that they need Mens or Misses items next to the size.
Age of Child 3
Gender of Child 3
Special Requests
Child 4
Please list the following information for child 4.
Age
Shirt Size
Pant Size
Underwear/Diaper Size
Bra Size (if applicable)
Sock Size
Shoe Size
If the child is in adult sized clothing please specify that they need Mens or Misses items next to the size.
Age of Child 4
Gender of Child 4
Special Requests
Child 5
Please list the following information for child 5.
Shirt Size
Pant Size
Underwear/Diaper Size
Bra Size (If Applicable)
Sock Size
Shoe Size
If the child is in adult sized clothing please specify if they need Mens or Misses items next to the size.
Age of Child 5
Gender of Child 5
Baby Equipment Request (NO bed requests)
Please list any needed baby equipment. Please note that availability may be limited due to the high demand for these items. ALL beds must be filled out in Kingsport.
Form Validation and Permission
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