Hidden fields





The form will automatically be displayed in English. To change what language the form questions show in, please select an option from the dropdown. 
You've been referred to Little Village but we have been asked to get more detail from you about what you require as your referrer was unsure. Please press next and fill in details
Refer a family to Little Village
Thank you for your interest in referring a family to Little Village. We provide clothes and equipment for babies and children up to the age of 5. Please make sure you explain to the family how Little Village works before making the referral. Unless there is information we need to clarify, we will not contact the family directly before delivering their bundle. Please make sure the information on the form is accurate. 
 

Important
Please note we have had to change our referral criteria due to a significant increase in requests for support. 

 We are currently only able to provide clothing and kit to: 

 • families with a newborn baby (30 weeks pregnant or baby under 3 months) or 
 
 • families in emergency situations with nothing for their children (for example: victims of domestic violence, trafficking, modern slavery or recent asylum arrivals). 

We are only able to provide clothing and kit for families who live in these boroughs. 
Unfortunately, we can't support the family at this time because they live outside our core boroughs. You can find links to other baby banks and other resources which may be useful on our website 
 
Your Details












Family Details
Thanks for providing all your information. Now we need some details about the person you're referring.







(Please note, we cannot deliver items to the family without a phone number. Please ensure this number is up to date and all digits are included - thanks!)


Referral Details


Please tell us how many people live in same household under categories below
Please check over the address and contact details to make sure this is correct. 



(Please note, we cannot deliver items to you without a phone number. Please ensure this number is up to date and all digits are included - thanks!)
Additional Family Information













This next section is about the items the family needs. We strongly recommend that referrers complete this information in discussion with the family and on their behalf. If preferred, we can send the family an email so they can complete the items needed. However, this may cause a delay in processing their referral. 

You have asked us to send the family an email to complete the rest of the referral.  
Child Details
Please complete this section for one child. If there are other children (including twins or triplets) up to the age of 5 who need items, please select “Add another child” below. Please enter the child’s actual age - you will be able to indicate below if the children are wearing clothes of a different age group.  



Items needed 

Most of the items we offer are donated and so we can only gift out what we have received from the public.  Because of this, we may not have all items available and during busy periods may need to limit what we can offer. 

Please make sure the family are aware that the majority of the items we send will be second hand. We make sure they are in great condition and quality, clean and fit for use.   

Please let us know what items are needed for this child by checking the relevant boxes and then selecting from the list below. If the child doesn’t need this item, please don’t check the box.  

 

If there are other children (including twins or triplets) up to the age of 5 who need items, please select “Add another child” at the bottom of the page after you have entered the items for the first child.

Items needed 

Most of the items we offer are donated and so we can only gift out what we have received from the public.  Because of this, we may not have all items available and during busy periods may need to limit what we can offer. 

Please be aware that the majority of the items we send will be second hand. We make sure they are in great condition and quality, clean and fit for use.   

Please let us know what items are needed for this child by checking the relevant boxes and then selecting from the list below. If the child doesn’t need this item, please don’t check the box.  

If there are other children (including twins or triplets) up to the age of 5 who need items, please select “Add another child” at the bottom of the page after you have entered the items for the first child.



















As you have chosen 'changing mat' and 'changing bag', we will send you only one of these items depending on availability



We’ll send a microwave steriliser if we can
As you have chosen 'Hair Chair' and 'Travel High Chair', we will send you only one of these items depending on availability




Have you entered in all children part of this multiple birth? 


Nearly finished!
Thank you very much for making this referral to Little Village. We will pack the family’s items as soon as we can and confirm the delivery date with them directly. We aim to respond within 4-6 weeks.  
Thank you very much for making this referral to Little Village. We will email the family a form to choose the items they need. We will aim to complete their referral within 4-6 weeks.

Please confirm if you are happy for us to keep you informed of Little Village’s news, fundraising efforts or about taking part in user surveys and events, by:
Thank you very much for letting us know about the items you’d like from Little Village. We will pack your items as soon as we can and confirm the delivery date with you directly. We will aim to complete your referral within 4-6 weeks. 

Please confirm if you are happy for us to keep you informed of Little Village’s news, fundraising efforts or about taking part in user surveys and events, by: