(500 character maximum)

Please check all of the counties that your organization or program will provide services.

Please indicate which areas of the Federal Poverty Levels are served by your program or organization.

Please indicate all of the channels that your organization currently receives diapers.

Please indicate whether diapers are required for participation in services provided by your organization.

1. Products provided by Babies Need Bottoms may not be sold, bartered or exchanged. 2. Products must be provided free of charge for all recipients. 3. Products received from Babies Need Bottoms may not be taken by volunteers, officers or employees for personal use. 4. Products you receive from Babies Need Bottoms must be used solely for charitable purposes, as defined under IRS Tax Code, such as families at or below 200% FPL, disabled or in crisis situations. 5. Basic demographic information may be required to participate in our programs, but no personally identifiable information on clients is required. 6. Failure to abide by the terms of our distribution program may result in the suspension and/or termination in our partnership. 7. There is no guarantee by Babies Need Bottoms to provide a minimum quantity of diapers, as our supplies are based upon community donations and variations in diaper need for other partners. 8. No warranties are made for the quality or condition of diapers provided by Babies Need Bottoms and partner organizations agree to indemnify and hold Babies Need Bottoms Inc., their affiliated agencies, officers, directors, contractors, agents, and employees harmless from any and all liability, loss, damages or expenses from all claims, demands, and actions (including but not limited to reasonable attorney’s fees) out of or in connection with the use or handling of these diapers by the Partner Organization, its employees, its clients, or anyone to whom it supplies the diapers.