Regional request form
Thanks for visiting St Kilda Mums Rural and Regional Service.
To access our service, all social workers and Maternal and Child Health nurses must be registered with St Kilda Mums.
If you are not yet registered, please register as a regional social worker here prior to completing this form.
We are still working hard to help as many families as we can despite restrictions due to COVID-19. Currently, donations from the public are extremely limited so please consider accessing available brokerage or funding before placing this order.
Until further notice, we are only able to offer two large (waitlisted) items per order - this applies to bassinets, cots, car restraints and prams. We apologise for any inconvenience while we try and meet the increasing demand in our community on fewer resources.
Please complete one form for each family you are requesting for, unless you are placing an order for bulk stock. In this instance, please add "bulk stock" in the "mother's or primary carers name" field.
For helpful hints on how to complete this form please click here.
For further assistance or for emergency requests, please contact the Regional Service Coordinator via email at firstname.lastname@example.org
We look forward to receiving your request soon - thank you for supporting families in need.