Regional Helpful hints
This guide is to support you to get the most from each request you make from St Kilda Mums.
Please note to access our service, all social workers and Maternal and Child Health Nurses must be registered with St Kilda Mums Regional and Rural Service.
If you are not yet registered, please register here prior to completing this form.
Please ensure that you complete one request form for each family.
For further assistance or for emergency requests, please contact the Regional Service Coordinator via email at email@example.com.
Q: Your name?
Please enter your full name including first name and surname. This should be the same name you used when you registered with us.
Q: Your organisation?
Please enter your organisation’s full name, do not put acronyms. If your organisation is Victoria wide, please include your organisation and the suburb it’s located, e.g. SalvoConnect – Belmont
Please enter the work email you used at registration - if you do not use your registered email address the form will not submit properly.
Q: Your mobile number?
Please enter your work mobile number in full. If you do not have a mobile number please enter your work’s main office number.
Q: Mother’s full name or reference (to prevent duplication of orders, the mother’s name is preferred)
Please enter the first name and surname for the mother of the child and/or children. This collection of personal information will be stored securely as required under the Australian Privacy Act. This is important for us to detect and prevent duplication of orders.
Q: What local government area (LGA) does this family reside in?
Please click on the text box and choose LGA.
Q: Does this family identify as Aboriginal or Torres Strait Islander?
Click on the text box and select the correct option.
Q: What are the causes of disadvantage for this family (you may select multiple items by holding down your Ctrl or command key on your keyboard)
Please click on the text box, select the cause from the list available. You may select more than one by holding down your Ctrl or command key on your keyboard.If you have selected ‘other’ please use the further notes or comments box at the end of this form just before you submit. In this box you can provide another cause for disadvantage.
Q: Does the family have a Health Care Card?
Please select Yes or No. This does not effect eligibility for our service.
Q: Is this family connected with other support services, if so who?
Please enter the other service(s) that this family is supported by. For example, Child Protection might also be supporting this family.
Q: What is the due date of baby or birth date of the of the youngest child? (Please write dd/mm/yyyy)
Please enter the day, month and year of the due date or the birth date of the youngest child in the family. Please ensure that it is entered in the format as requested above.
Q: Baby’s gender?
Please select what applies to the youngest child. If there are twins, please select twins and let us know the gender of them in the further notes or comments box located at the end of this form.
Q: As of today, how many babies does this family have that are younger than 12 months (including the one(s) due)?
Please enter the number of babies, under 12 months of age in this family. This is to also include any babies yet to be born. For example there are two babies (twins) 11 months old, mum is eight weeks pregnant. So please enter three babies.
Q: How many children are there in total in this family? (please include baby or babies due to be born)
Please enter the total number of babies (under 12 months of age) and children in this family you are requesting for. For example, mum is 11 weeks pregnant, there is a two-year-old boy, seven year old girl and 12 year old girl. Please enter four children.
Q: What are the age(s) and gender of the older siblings? (Please write G5, B6, etc)
Please enter the age and gender of children (older than 12 months) for the family you are requesting for. For example if there is a 1 year-old boy and three year-old girl please enter – B1 and G3.
Q: Cot and mattress
Please enter what the family needs, note that all cots include mattresses. If not required just leave empty.
If you are asking only for a mattress make sure you have all the details from the cot, particularly the required measurements for the mattress as this is a key safety feature.
Q: Pram (please choose only one)
Please enter a "1" on the appropriate pram for this family. If not required just leave empty.
Q: Car restraints
Please enter a "1" on the correct car restraint for the baby, child or children. If the family needs more than one of the same car restraint type, please enter a "2" or "3" accordingly. If not required just leave empty.
It is the law for all children up to the age of 7 to be in a child restraint or booster seat when travelling in a vehicle. Choosing the right child restraint for a child will depend on their age and size.
To keep a child safe, the restraint must also be properly adjusted, fastened, and fitted to the vehicle. More information is available from the Vic Roads website.
All Geelong Mums car restraints have tether straps and come with a Hire for Baby voucher, which is a free service available for each car restraint to ensure fitting is completed by a trained professional.
If you select nappies please tell us which size(s) you require in the box located at the end of this form. If not required just leave empty.
Please note that the nappy sizes listed below are a guide only, so to ensure the correct size(s) is provided please obtain accurate sizing from your families.
Q: Other items
Please enter "1" on the items the family needs, you can enter "2" or "3" if requesting for multiple children (like highchairs). If not required just leave empty.
If asking for formula or toiletries, please specify the type on the relevant box.
If you select safety gate, please tell us the width of the safety gate required in the further notes or comments box located at the end of this form.
Please enter "1" on the relevant box for size and gender. If not required just leave empty. For example, G4-5 means girls size four and five and B7-8 is boys size 7 and 8. Please note that clothing bags contain 80-100 items.
Please note that although we officially only go up to size 12 in children’s clothing, we do hold onto some clothing from size 13 to size 16 (children) for when larger sizes are required. These are a smaller clothing bag and not full like our other clothing bags. If required, please record in the further notes or comments box located at the end of this form.
Please enter "1" on the relevant box for size and gender. If not required just leave empty.
Single bed packs include doona cover, pillowcase, sheets, mattress protector and small throw blanket. We do not re-home doonas, single bed blankets or pillows.
Q: Do you have any further notes or comments about this request?
Please click on this text box to enter any further information you can provide about your request or for any additional needs.
Q: Please confirm that you agree with the terms of our Service Policy?
Please read our service policy if you haven’t already and click on the text box to select Yes.