Bakersfield Pregnancy Center

First name*

Last name*

Email*

Cell Phone*

Baby's/ Babies' Name*

Baby's/ Babies' Age*

Diaper Size Request

Newborn12

Currently only sizes 1 & 2 available

Wipes Request

YesNo

Formula Request

List what kind you are requesting (preferred brand, type of formula, size requested, alternate brand (if the preferred brand is unavailable).

I understand availability depends on our c.urrent supply and we can’t guarantee fulfillment.

YesNo

We’ll always do our best to help!

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