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We will reopen on the 20th January 2021. Click here for our closure information.
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Order Form
Your Name
*
Your Email Address
*
Your Mobile Number
*
(Please enter your 10 digit mobile number)
example: 0400111333
Your organisation full name
*
(Please Do not use abbreviation)
Parent's full name or Initials for reference (this will be kept confidential)
*
Does the family identify as Aboriginal or Torres Strait Islander?
*
--None--
Yes
No
Is the family affected by COVID19 at all (either directly or indirectly)?
*
--None--
Yes
No
What are the cause/s of disadvantage for this family? (Please select as many as are relevant)
*
Asylum Seeker
Disabillity
Family Reunification
Family Violence
Foster Care
Homelessness
Job Loss
Kinship Care
Life - Controlling addiction
Mental Health
Migrant
Natural Disaster
Physical Health
Refugee
Single Parent
Young Mother
Young Parent
Which Local Government Area is the family located in?
*
Ballina
Brisbane
Gold Coast
Ipswich
Lismore
Logan
Redland
Southern Downs
Toowomba
Tweed Heads
Weipa
Other
If you can't find the Local Government Area above, please tell us where the family resides:
*
How many children are there in the family?
*
If there is an unborn child, when is the baby due (Closest approx date)?
What are the ages and genders of the children in the family (including unborn)?
Gender (M/F/?)
Age (Months)
Clothing size
Provide Clothes (Y/N)?
Baby 1
--
Unknown
Girl
Boy
Unknown
--
Unborn
1
2
3
4
5
6
7
8
9
10
11
--
Prem
Baby
Baby 2
--
Girl
Boy
Unknown
--
Unborn
1
2
3
4
5
6
7
8
9
10
11
--
Prem
Baby
Complete below for children over 1 year
Gender (M/F/?)
Age (Years)
Clothing size
Provide Clothes (Y/N)?
Child A
--
Girl
Boy
--
1
2
3
4
5
6
7
8
9
10
11
12
--
1
2
3
4
5
6
7
8
9
10
11
12
Child B
--
Girl
Boy
--
1
2
3
4
5
6
7
8
9
10
11
12
--
1
2
3
4
5
6
7
8
9
10
11
12
Child C
--
Girl
Boy
--
1
2
3
4
5
6
7
8
9
10
11
12
--
1
2
3
4
5
6
7
8
9
10
11
12
Please let us know nappy size, child's weight and/or shoe size
Can you tell us more about this family's story?
*
Can we use this de-identified story in our communications?
*
Yes
No
Ok to Share with Volunteers
Does the family need a cot or bassinet? (We are unable to provide both for a single child due to high demand and waitlist - if the family has twins, you can request two. Please note that cots are recommended from birth, and bassinets only last until the baby can roll, which can be as young as 10 weeks)
Quantity
Cot
Highchair
Bassinet
Single Pram
Double Pram
If you have requested a double pram, please give us any details about the family’s need to help us prioritize our waitlist (e.g. no car) and whether they require a stacker or side by side pram.
Do the family require car seats?
Quantity
Capsule (Newborn to approx. 6 months)
Reversible (Newborn to 4 years)
Forward Facing - (approx. 6 months+)
Booster - 14kgs+
What other items would you like to request?
Baby Bath
Bottle Pack
Bouncer / Rocker
Breast Pads
Carrier
Change Mat
Feeding Pack
Formula
Highchair
Maternity pads
Nappies
Nappy Bag
Toiletries for children
Toiletries for Mum
Toiletries for Dad
Toy Packs
Wipes
Are there any other items or detail you would like to add to this request?
Please let us know your preferred date for collecting this order. As the demand on our service has significantly increased, we now require 5 business day's notice to prepare orders. If your order is urgent, you can contact Lauren on
requests@babygiveback.org
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