Request Form

This form is for Caseworkers, Support Workers and Medical Professionals only.

Are you a caseworker?

YesNo, I am a parent/carer looking for help for my family

Thank you for reaching out to us for support. We appreciate that it can be a difficult thing to do.

Baby Give Back is unable to provide direct support to families. We work with caseworkers, social service agencies and health professionals, who are able to assess your individual needs. If you are already connected with a service agency, they can place an order for items on your behalf.

If you are not connected with a service agency, you can contact an organisation in your local area or talk to your midwife. For help with family and parenting challenges, you can also contact Family and Child Connect on 13 32 64. Once you are engaged with a service or enrolled in a support program, they can place an order for you and one of our team will be in touch with them directly.

Please do not click the 'Next Page' button below.

Is this the first time you are submitting a request to us?

YesNo

Have you read our Collection Policy and do you understand our requests procedures?

YesNo

Please read the Agency Support page on our website and contact requests@babygiveback.org for further information.

Do you agree to our Collection Policy?

Yes

Caseworker Information

Your details

Caseworker First Name

Caseworker Last Name

Caseworker Email

Caseworker Mobile Phone Number

Your organisation name

Please do not use abbreviations here.

Position/Title

Your office location (Suburb only):

Is the family being supported by another organisation or support worker?

YesNo

If yes, please provide the name of the organisation/support worker and add any relevant information here (eg. I have confirmed with xx that we will order) so we can ensure there is no duplication.

Is this an urgent request requiring a response within 48 hours? eg. child welfare concerns or urgent need for a cot or formula

YesNo

Please provide a reason in the box below

How would you like to receive this order?

Please tick which days you are available to collect your order from our Gold Coast warehouse in Varsity Lakes:

MondayTuesdayWednesdayThursdayFriday

Notes regarding your collection availability:

Please provide the details of the person collecting the order on your behalf.

First name and last name

Organisation

Email / Mobile Number

Please choose your delivery option:

Please note: delivery to Logan Hospital is for hospital staff use only

Please note: delivery to Mater Hospital is for hospital staff use only

Please note: delivery to Northern NSW is for flood affected families

After submitting this form, please email requests@babygiveback.org with your order number and delivery address to receive a quote

Please provide your office address to receive a delivery quote:

Family Information

Parent's full name for reference (this will be kept confidential)

How many children are there in the family?

Please include any unborn child/ren

Please tell us the ages and genders of all children in the family: (e.g. Boy 6yrs, Girl unborn, Boy 6 months)

Remember to include the unborn child/ren

Family Story - Please tell us about this family's situation. This information is critical for us to be able to prioritise stock available for those most in need and to ensure that the items we provide are appropriate for this family.

Can we use the family's story de-identified in our communications?

Does the family identify as Aboriginal or Torres Strait Islander?

Are any of the following circumstances relevant for this family? Please tick all that apply

Culturally and Linguistically Diverse	Disability
Family Reunification	Foster Care
Kinship Care	LGBTQIA+
Single Parent	Young Parent

Which family member/s has a disability

Is the single parent the mother or father of the child/ren?

Is the young parent the mother or father of the child/ren?

Are any of these factors affecting this family? Please tick all that apply.

Asylum Seeker/Refugee	Family Violence
Homelessness	Job Loss
Life-Controlling Addiction	Mental Health
Migrant	Natural Disaster
Physical Health

Please specify the stage of family violence

Please specify the stage of homelessness

Which Local Government Area is the family located in?

If you can't find the Local Government Area above, please tell us where the family resides

What is the family's postcode?

Items Required

We supply essential items for children up to the age of 5 years. Please tell us below which items you would like to request for each child in this family. Start with the youngest child (unborn baby if applicable).

CHILD A

Gender

Age

Items requested:

Clothing

Size Required?

Clothing

Size Required?

When is the baby's due date?

Please select from the date picker or type in format DD/MM/YYYY

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Car Seat

What style of car seat is needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

CHILD B

Gender

Age

Items requested:

Clothing

Size Required?

Clothing

Size Required?

When is the baby's due date?

Please select from the date picker or type in format DD/MM/YYYY

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Car Seat

What style of car seat is needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

CHILD C

Gender

Age

Items requested:

Clothing

Size Required?

Clothing

Size Required?

When is the baby's due date?

Please select from the date picker or type in format DD/MM/YYYY

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Car Seat

What style of car seat is needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

CHILD D

Gender

Age

Items requested:

Clothing

Size Required?

Clothing

Size Required?

When is the baby's due date?

Please select from the date picker or type in format DD/MM/YYYY

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Car Seat

What style of car seat is needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

CHILD E

Gender

Age

Items requested:

Clothing

Size Required?

Clothing

Size Required?

When is the baby's due date?

Please select from the date picker or type in format DD/MM/YYYY

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Safe Start Box

This is a starter kit for mother and baby containing nappies, toiletries, breast and maternity pads.

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Formula

Brand or dietary requirements:

Large Item

Which item is most needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Nappies

Size Required?

Car Seat

What style of car seat is needed for this child?

Please let us know any circumstances or safety information about the child's need for this large item so we can allocate accordingly:

Note: We do our best to meet the safety needs of families but we'll be in touch with you to confirm if large items are available for this family.

Other Essentials or Further Detail

Please advise if there are any other essential items you would like to request for this family that have not been listed above.

Reminder: You have selected to have this order delivered to you at your cost - after submitting this form, please email requests@babygiveback.org with your order number and delivery address to receive a quote.

Please ensure you have entered all information correctly.

We are supporting hundreds of families each month and prioritise requests based on the information you provide.

If you have any updates on the family's circumstances or receive items for this family from any other organisation, please let us know as soon as possible. We welcome any conversations about brokerage or funding, please contact us on the email below:

Email: requests@babygiveback.org

By submitting this form you agree to our Privacy Policy and consent to us providing details of your request to a third party for the purpose of securing donations of items or funding.