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This form must be completed in advance of diaper pick-up.

Montgomery, Alabama residents who are parents, guardians or caregivers for children 3 1/2 years of age or younger (42 months). Applicants must provide number of children in household.


  • I understand that Express-O of Love Diaper Bank provides donated diapers as received and cannot accommodate specific requests for styles or brands. As available, baby wipes may also be distributed. The Express-O of Love Diaper Bank cannot make any guarantees of availability.

  • I understand that each family is asked to sign a product liability waiver as all diapers/wipes are donations provided to Express-O of Love solely for the purpose of the Diaper Bank distribution to families in need of diapers and the Diaper Bank does not take on any responsibility or liability whatsoever for products its distributing.

  • I understand that the diapers are for the sole purpose of my child in need and not to be sold or distributed to other people.

  • I understand that the service is for Montgomery, Ala. residents.

  • Express‐O of Love may use your photos for photographer, business, or individual seeking the rights to use the image, likeness, or video for promotion.

One Application Per Child

Client Application
Relationship to Child
Child's Race

PLEASE NOTE: If this is an emergency diaper pick-up, please call (205) 538-0062 or email:

Thank you for submitting and mark your calendar. If you have any questions, please call us at 205.538.0062.

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