Stripey Stork Referral Form

Page 1

Welcome to Stripey Stork's referral form.

Please complete the form - there are four pages - adding a new section for each household member.  You can add the items needed for each individual, adding up to a maximum of thirty different items.

If you would like to refer more than one family, please ensure you complete this form and click Submit before completing a new form.
If you have any queries, please contact refer@stripeystork.org.uk.

And for further information about how we use your data, please click here. 

Referral policy - please read
If you are unable to agree to our referral policy we cannot process your referral further. Please contact info@stripeystork.org.uk for further information
Your Details
Please select your type of organisation and then the name of the organisation. If you are unable to find your organisation name, please select NOT LISTED and complete the following questions.

Please indicate the category that best describes your organization.








We collect geographical information to derive the areas where our service is most needed and used. We store this data securely, and take measures to prevent it from being disclosed to third parties. The data is collected via our referral partners, and is only used in aggregated form to assess the impact of our work. The system we are using to manage referrals data is Salesforce, the world’s #1 cloud-based CRM system. It has robust data security measures in place. You can find out more about how Salesforce protects your data here (https://trust.salesforce.com/en/).

Page 2

Please provide information about the household and individual family members.Click on add another child to add more.

Household info


Include children due to join your household, as well as unborn children

We collect geographical information to derive the areas where our service is most needed and used. We store this data securely, and take measures to prevent it from being disclosed to third parties. The data is collected via our referral partners, and is only used in aggregated form to assess the impact of our work. The system we are using to manage referrals data is Salesforce, the world’s #1 cloud-based CRM system. It has robust data security measures in place. You can find out more about how Salesforce protects your data here (https://trust.salesforce.com/en/).



Tick any that are applicable


Please complete for all children in the household. Click 'add another child' to add the next child.


Page 3

Please complete a request for each item, click on Request another item to add further items.

Items - complete for each item


NB
Pressure-mounted safety gates should NOT be used at the top of the stairs
NB

When you select nappies or pull-ups, two packs of wipes are added as an add-on product to the existing item.

NB

When you select cots / cot beds, a cot mobile is added as an add-on product to the existing item.

NB

When you select Prams and Buggy, cozy toes and a blanket are added as an add-on product to the existing item.

NB

When you select Highchair, a weaning bag is added as an add-on product to the existing item.

NB

When you select sleeping product can you please add the age and gender of the child in comment section.

NB

When you select Toy bundle, a book bag is added as an add-on product to the existing item.

NB

Subject to availability our Clothes Bags include as standard:

a winter coat

lightweight coat

hat

jumpers

long sleeved t-shirts

short sleeved t-shirts

shorts

skirts

dresses

pyjamas

new underwear

socks

When available they may contain extras such as sports clothing, dressing gowns and swimwear

NB
Overnight packs are for ages 14-18 years, and contain approximately a weekend’s worth of clothing, plus pjs, new underwear and socks, plus a wash kit, toiletries and towel. For comfort they include a pillowcase and blanket, and some self-care items like a notebook and pens, hairbrush and lip balm. They are ideal for teenagers in temporary accommodation or who have been moved at short notice.
NB
Subject to availability our Newborn Pack will include: baby clothing (newborn and 0-3 months), a baby bath, Moses basket and stand, sheets and blankets, sleeping bags, a change mat, towels, bibs, muslins, nappies (size 1 or 2) and wipes, a filled hospital/change bag, toiletries, and toys
NB
Please choose suitable Activity pack for the age of the child. Activity packs are not suitable for under 3 year old.

Activity Pack Pre-school age range is 3-5 years,
Activity Pack infants age range is 5-8 years,
Activity Pack Junior age range is 8-11 years,
Activity Pack Teen age range is 11+ years.






Page 4

Last few bits and pieces


PLEASE NOTE WE ARE UNABLE TO DELIVER DIRECTLY TO FAMILIES


You have selected a delivery slot, and you will be sent an email with a link to our delivery slot booking page, when you have submitted this form..

 

Delivery Options:

We have existing arrangements with some referrers - if you know your organisation or school regularly receives deliveries from us, you should be able to find your delivery location on the 'internal only' list. Contact us if you're not sure.

 

We have delivery hub options around the region - partners who allow us to deliver to them so that other referrers close to that area can make a more local collection. Any partner can use these - please have a look at the 'Open to all' options on the list and select one you can travel to. 

 

If you do not have a delivery arrangement with us, please contact us at refer@stripeystork.org.uk to enquire.

Delivery slots are limited and we cannot guarantee availability.

You have selected a collection slot, and you will be sent an email with a link to our collection slot booking page, when you have submitted this form.

Please note that if you have selected only school items, you will be sent an email with a link to book a collection slot at Raven House, a different location from our usual Reigate site. You can only book a collection slot from Raven House for these types of referral.


If you have another referral for a different household to make, make sure you submit this form first, then start the process again refreshing your screen.

Contact Information