Delivery Help For Mothers & Families

Non-emergency pickup and delivery of essential items in support of pregnant women and families with young children.

NON-PASSENGER PICKUP/DELIVERY FORM

This form is used solely to request pickup/delivery services provided by America Needs Babies Foundation (ANBF) for non-emergency purposes.

Services provided by ANBF are not for emergencies. If you are experiencing a medical emergency or any emergency, call 911.

ORIGINATOR *

DATE *

TIME *

Hours

Minutes

AM/PM

Requested date and time are used for planning purposes only and do not guarantee availability. ANBF will confirm if pickup/delivery can be provided.

Drivers’ operating hours are 8am-5pm, M-F. First available pickup at 9am and the last pickup at 4pm. Services unavailable on National and State holidays.

Please allow flexibility of at least plus or minus 30 minutes. Exact pickup times cannot be guaranteed.

CLIENT INFORMATION

First Name *

Last Name *

Age in Years – Pickups/Deliveries cannot be made to/from recipients under 18 years of age *

MOBILE PHONE NUMBER (required) *A mobile phone number is required. ANBF uses calls and text messages for time-sensitive coordination. If we are unable to reach you, services may be canceled. Text messages are limited to coordination of services only.

PICKUP ADDRESS

Street Address *

City *

DELIVERY ADDRESS

Street Address *

City *

This request is for item pickup/delivery (not passenger transportation)

DESCRIPTION OF ITEMS TO BE PICKED-UP OR DROPPED-OFF *Examples (not limited to): diapers, wipes, formula, baby food, clothing (NB-5T), toys, strollers, car restraints. Items must be legal, non-hazardous, and reasonably handled by one driver.

CONSENT & RELEASE

I understand that pickup/delivery services are provided by volunteers or contractors, are subject to availability, and are not for medical or other emergencies.

Services are provided subject to availability and do not create an ongoing obligation or entitlement to future services.

Requested dates and time are not guaranteed and do not constitute confirmation of services.

ANBF does not provide insurance coverage for services beyond what is required by law.

I voluntarily request assistance and release ANBF from liability except in cases of gross negligence.

I have read and agree to the preceding Consent & Releasse