Test Request Form

St Kilda Mums Order Form

Welcome to the online request form for St Kilda Mums. If you are located in rural or regional Victoria please use this link.

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

We are still working hard to help as many families as we can despite restrictions due to COVID-19. While we are currently closed for donations 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, please contact the Social Services Team at request@stkildamums.org.

All fields with * are mandatory and must be completed.

Your Details

Your name*

Your organisation*

Your email*

Your mobile number*

example: 0400111333

Family Information

Mother's or primary carer's full name (to prevent duplication of orders, for example: Jane Doe)*

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.)*

Other disadvantages*

Is DHHS involved with this family/child?*

Has this family been affected adversely by COVID-19?*

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?*

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 Kit (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

Please 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

Please specify the sizes here

Cloth Nappies

Nappy Bag

Safety Kit (drawer/cupboard locks, power point covers etc)

Safety Gate

Steriliser

Toiletries Packs: Baby or Child

Toiletries Packs: Adult

Toiletries Packs: OMTA Packs

Toys Bags and Playmats

Books and Craft Packs

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
13-14
15-16

Clothing bags

Shoes: If shoes are needed, please enter the number of packs on the size required, note that there are approximately 5 pairs of shoes per pack (C = child, Y = youth)

Size	Boy	Girl
C5
C6
C7
C8
C9
C10
C11
C12
C13
Y1
Y2
Y3
Y4
Y5
Y6
Y7

Linen bags

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

Size	Boy	Girl	Unisex
Bassinet
Cot
Single Bed

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

Opening Times

Clayton opening times at 14 Winterton Rd, Clayton

Monday - Friday 10am - 3pm

We will be in touch as soon as the items are available to collect.

St Kilda Mums is adhering to current government guidelines with social distancing, hygiene and contact-less collections.