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. Unfortunately, we have had to close again for goods donations, so some items are in low supply. We will do our best to fill your order as completely as possible.

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 regional@stkildamums.org

We look forward to receiving your request soon - thank you for supporting families in need.

Your Details

example: 0400111333

Family Information

Items Required

Size Boy Girl
UniPrem:
Prem
0-6 m
6-12 m
1-2
2-3
3-4
5-6
7-8
9-10
11-12
13-14
15-16
 Size   Boy  Girl
C3
C4
C5
C6
C7
C8
C9
C10
C11
C12
C13
Y1
Y2
Y3
Y4
Y5
Y6
Y7
 Size   Boy  Girl Unisex
Bassinet
Cot
Single Bed