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Summer's Sunshine

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Request for Emergency Baby Safety Items

This form is for expecting or new mothers who do not have essential safety items needed to bring their baby home or keep them safe, such as a car seat or a safe sleep arrangement (such as a crib or bassinet). If you are facing this kind of hardship, please complete this application so we can work to connect you with these critical items before or shortly after your baby’s arrival.

Please note: Once a hardship baby care item request has been fulfilled, another request cannot be submitted or considered for a period of 2 months.

Applicant Information

First name(required)

Last name(required)

Email(required)

Phone number(required)

Preferred Method of Contact(required)

Mailing Address

Household Information

This information enables us to make sure the amount of aid we supply is enough to support all in need and helps us quantify our impact at the end of the year (i.e., be able to put a number to how many people we helped in a year).
This info is never shared with any other parties and is never used to determine whether aid is needed.

Number of people in household(required)

Due date or infant’s date of birth (YYYY-MM-DD)(required)

Housing Situation

Household Income

Other public assistance received (select all that apply)

SNAP WIC Food pantries Other

Need-Specific Details

Please describe your hardship and how Summer’s Sunshine can help address your urgent need.(required)

Which essential baby safety items are needed?(required)

Car seat A place to sleep safely (like a bassinet or pack-n-play) Sleep sack

Hospital name and address for item delivery (required)

Prior Assistance History

Have you received assistance from us before?(required)

Yes No

If so, when and for what?

Referral/Discovery

How did you hear about us?

Consent & Signature

Do you consent to be contacted?(required)

Yes No

I attest that the information provided is accurate (required)

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Summer's Sunshine

We’re a northern Virginia-based 501(c)(3) non-profit organization providing nutritious meals, basic necessities, and other means of tangible support to at-risk mothers and young children.

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