Request Form

St Kilda Mums Order Form

If you are not yet registered, please register here before completing this form.

Please note, complete one form for each family you are requesting for.

For helpful hints on how to complete this form please click here.   

For further assistance, please contact the Social Services Team via email.

All fields with * are mandatory and must be completed.

Your Details

Your name *                 

Your organisation *      

Your email *                 

Your mobile number *

Family Information

Mother's name (to prevent duplication of orders)*

What Local Government Area does the family live in? *

Does this family identify as Aboriginal or Torres Strait Islander? *  

Does the family have a health care card? *

What are the causes of disadvantage for this family?*

You may select multiple items by holding down your Ctrl or command key. If you chose 'other', please add details here

Is DHHS involved with this family/child?*

Is this family connected with other support services? If so, who?

What is the due date of the baby or the birth date of the youngest child? (Please write dd/mm/yyyy) *

Baby or youngest child's gender? *

How many children are in the family in total? *

How many are we directly supporting with this request (including babies due to be born)?   *

How many are younger than 12 months (including the one(s) due)? *

What the the age(s) and gender of the older siblings? (Please write G5, B6 etc.) 

Items Required

If an item is not required just leave it blank

Cot or bassinet: Please select either cot or bassinet (cot is preferred)

Cot: please enter 1 here (2 for twins)

Bassinet: please enter 1 here (2 for twins)

Pram: Enter 1 in preferred pram type 

Single Pram:
Stacker/Tandem Pram:
Side by Side Double Pram:

If the family needs a quad or triple pram please enter 1 and we will contact you to confirm the most suitable solution.
Triple: Quad:

Car Restraint: Please enter 1 next to the type. If you need more than one car restraint (for siblings or multiples) please enter the relevant number next to each type.

Capsule (NB-6 months, up to 12 Kgs):
Reversible (NB-4 years, up to 18 Kgs):
Toddler (1-4 years, up to 26 Kgs):
Booster (4 years+, from 14 Kgs): 

Other Items: Please enter 1 next to any required items. Please note we rely on donations, so we cannot guarantee supply but we'll do our best.

Baby Front Carrier:
Bath:
Breast Pump Kit (only available once baby is born): 
Bottles (only available once baby is born):
Bouncer:
Breast Feeding Pillow:
Breast or Maternity Pads Pack:
Change Table:
Change Mat:
Coats:
First Food Kit (utensils and equipment):
Formula (only available once baby is born):
Highchair:
Mattress for Cot: If they have a good condition compliant cot and just need a mattress, please enter 1 here and specify the required mattress size here  (you should find these measurements on the base of the cot)
Nappies: Please enter the number of children you are requesting nappies for here  
and specify the sizes here 
Cloth Nappies:
Nappy Bag:
Playpen:
Safety Kit (drawer/cupboard locks, power point covers etc):
Safety Gate:
Steriliser:
Toiletries Pack: Baby or Adult please specify here 
(Baby or Adult)
Toys Bags/Activity Mats/Books & Puzzle Bags:
Wipes:

  

Clothing bags 

Please enter the number of bags required per size, please note the clothing bags contain 80-100 items.

 Size   Boy  Girl
 UniPrem: 
Prem     
Birth-1    
1-2    
2-3
3-4
4-5
5-6
7-8
9-10
11-12

 

Linen bags

Please enter the number of bags required. These include wraps and sleeping bags.  

 Cot Boy:   Bassinet Boy: 
 Cot Girl:   Bassinet Girl: 
 Cot Unisex:   Bassinet Unisex: 

Do you have any further notes or comments to make about this request?

Please confirm that you agree with the terms of our Service Policy? *

Opening Times

Our opening hours for collections are: 
Monday and Tuesday 12:30 - 2 pm
Wednesdays and Thursdays 9:30 - 11 am

Criteria for collection:

  • Your order doesn’t contain a cot, pram or car restraint.
  • Clients must be 6 months or 28 weeks pregnant to book a pick up date.  If you are ordering before your client is 28 weeks pregnant you will need to email us closer to the due date to schedule collection. We will also send you a reminder. 
  • If you are collecting clothing, toys and nappies only you can schedule to collect within 2 business days.

 If this order meets this criteria please select your preferred collection date

We will contact you if we have any queries with your order, in which case your preferred day of collection must be postponed until the issue is resolved. 

Due to stock constraints we will contact you to arrange a collection date for a cot, pram or car restraint.