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The form will automatically be displayed in English. To change what language the form questions show in, please select an option from the dropdown. 
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. If you have any active or recent safeguarding concerns regarding this family please email referrals@littlevillagehq.org and we will be in contact with you within 24 hours to discuss. 

You have the option to save this form. We strongly recommend you do this at the end, before clicking submit, to allow all your responses to be saved. In the event the daily cap has been met before you submit the form, saving it means you will be able to access your completed answers again using the link which will be emailed to you. You will then be able to submit your completed form from 9.30am the following working day. Once saved, please be sure to close the form fully and relaunch it before submitting.

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 
 

We will support the family through their existing referral and are unable to take a second referral for them at this time. You can reassure the family that we will be in touch regarding their original referral if we have not yet done so.  A family may be referred once every 3 months, or 3 months after a baby is born.

Please answer no if this referral is also for older siblings who need support.
We will be very happy to support the family closer to the baby's due date, but have to use our current newborn stock for more urgent cases. Please only submit a referral when mother is past 30 weeks pregnant.

Unfortunately, we have limited capacity so are unable to accept referrals that are only for smaller items such as nappies, toys and books.

Your Details











Please enter in numbers with no spaces

Please enter in numbers with no spaces
Family Details
Thanks for providing all your information. Now we need some details about the family you're referring.  Please enter details for the Parent/Caregiver on this page.



Address Information
Enter the postcode below and click 'Search for address'.

Choose from the options provided.

If you don't know the postcode, look it up here:

https://www.royalmail.com/find-a-postcode

If the address is not listed, choose the closest match from the options provided. Let the team know about any corrections in the 'Delivery Notes' section below.












PLEASE ENTER NUMBERS ONLY - DO NOT LEAVE ANY SPACES

We cannot deliver to families without an accurate phone number.


Referral Details


Please tell us how many people live in same household under categories below:
Additional Family Information











Child Details
Please complete this section for one child. If there are other children (including twins or triplets) up to the age of 5, you will have an opportunity to add another child after you have selected 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 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 is needed for this child by selecting the relevant item. If not needed, please leave blank.







Click this text to see pictures of the available buggy/stroller options. If you are selecting items for several children on this referral, please only choose one travel system that would best suit the family and we will do our best to provide it if available.
    • We are unable to supply buggies for children over 2 years.
    • We are unable to supply double buggies for children over 18m. 
If there is a medical need for a 2 year+ child needing a stroller please explain this in the free text box at the end of the form - this will be assessed on a case by case basis depending on both suitability and availability. 


Please note that availability of buggies, strollers and beds is dependent on donations

In order to reduce the amount of time it takes to fill out this form we have reduced the list of items to choose from, please be reassured we will be either calling or meeting the family at a shop appointment to go through any additional item requests in more detail e.g feeding, bathing equipment.





PLEASE CLICK ON the +Add another child LINK BELOW IF THERE ARE OTHER CHILDREN (INCLUDING TWINS OR TRIPLETS) UP TO THE AGE OF 5 WHO NEED ITEMS:


Please double check that you have entered requests for all children who are part of this multiple birth by clicking on +Add another child above.

Thank you for listing the family's needs - that is extremely helpful. Because of their location, this family is eligible to book an appointment to choose specific items at one of our sites. Please note, everything apart from large kit, such as beds and buggies, will have to be transported home by the family. We can arrange for large kit to be delivered.




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 direct you to an appointment booking page in a moment so that you can choose a time/date for the family to visit a local Little Village site.
Thank you very much for making this referral to Little Village. We will send the person you are referring a link to an appointment booking page in a moment so that they can choose a date/time to visit a local Little Village site.

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:
We strongly advise you save your form by following the 'save progress and resume' link at the bottom of the page, before you click submit. In the event the daily cap has been met (and you cannot submit this form today), you will be able to access your completed form again using the link which will be emailed to you. The link will only be sent if you opt to save progress. Finally, if you have any active or recent safeguarding concerns regarding this family please email referrals@littlevillagehq.org and we will be in contact with you within 24 hours to discuss. 
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