Request Form Special Campaigns

St Kilda Mums Order Form for Special Campaigns

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

This form is to be used for special campaigns where you ask for certain items for multiple families, like "back to school", "one mother to another", etc.

For normal orders with one form for each family and the regular scope of items, please use this form.

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 *

example: 0400111333

Family Information

What Local Government Area do most of the families live in?*

Do most of the families identify as Aboriginal or Torres Strait Islander?*

Do most of the families have a health care card?*

What are the most common causes of disadvantage for these families? (You may select multiple items by holding down your Ctrl or command key)*

Other disadvantages*

Is DHHS involved with most of these families/children?*

Are these families connected with other support services? If so, who?

How many families are you requesting assistance for?*

How many children are in the families 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)?*

Items Required

Please enter the number of required items next to what you require. Please note we rely on donations, so we cannot guarantee supply but we'll do our best.

Coats

One mother to another packs

Back to School Packs

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

Collection:

Please select your preferred collection date with at least 2 business days notice

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.