Request form

Thanks for visiting Geelong Mums!

To access our services all caseworkers, social workers and maternal and child health nurses must be registered with Geelong Mums.

If you are not yet registered, please register here prior to completing this form.

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 or for emergency requests, please contact the Social Services Coordinator via email or on 0481 184 465.

We look forward to receiving your request soon - thank you for your support of families in need.

Important to note: We are experiencing an ongoing high demand for reversible and toddler car seats and cots. We ask that you please explore all other avenues to access these items before requesting them through us. This includes Maternal and Child Health Services - Nursery Equipment Program and any available funding or brokerage.

Your Details

Your name*

Your organisation*

Your email*

Your mobile number*

example: 0400111333

Family Information

Mother's full name, primary carer's name (to prevent duplication of orders, the mother’s name is preferred)*

What suburb does this family reside 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*

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 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.)

How many are we directly supporting with this request (including babies due to be born)?*

Items Required

Cot: Does the family require one? If so, please enter 1 here (2 for twins)

If the family has a cot in good condition that complies with the current regulation and only needs a mattress, please enter 1 here

Please specify the details of the cot on notes and specify the required mattress size here (length, width and height, you should find these measurements on the base of the cot)

Pram: Enter 1 in preferred pram type

Single Pram

Stacker/Tandem Pram

Side by Side Double Pram

We try to match the best pram for the family, please indicate if they have a car or they rely on public transport and/or any details relevant for pram/stroller selection.

If the family needs a multiples pram please enter 1 and we will contact you to confirm the most suitable solution.

Triple

Quad

Car Restraint: Does the family require one? If so, 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 the 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)

Nappies: If the family needs nappies, please enter the number of children you are requesting nappies for here

Please specify the sizes here. Note that wipes will be automatically allocated with any nappies provided.

Other Items: Please enter 1 next to the following items in case the family would need any. If they need more than one please enter the number but remember that many items come in packs or kits. 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 Mat

Coats

First Feeding Kit (utensils and equipment)

Formula (only available once baby is born)

Highchair

Cloth Nappies

Nappy Bag

Playpen

Safety Gate

Steriliser

Toiletries Packs: Baby or Child

Female Toiletries - Adult

Male Toiletries - Adult

Toy Bags and Playmats

Books and Craft Packs

Clothes

If clothes are needed, please enter the number of clothing bags on the size required. Please note that clothing bags contain 80-100 items.

Size	Boy	Girl
Uni Prem:
Prem (Size 00000)
0-3 m (Size 0000 - 000)
3-12 m (Size 00-0)
1-2
2-3
3-4
5-6
7-8
9-10
11-12
13-14
15-16

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. Please note shoe size does not correlate to child's age. (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
Cot
Single Bed

Do you have any special requests, further notes or comments about this request?

Opening Times

Our opening hours for collections are Monday to Friday from 10:00am to 2:00pm.

Criteria for collection:

Pick up must be at least 2 business days from date of order. This is to give us enough time to prepare stock for you.
Clients must be 6 months or 28 weeks pregnant to book a collection date. If you are ordering before your client is 28 weeks pregnant you will need to email us closer to the due date to schedule collection. We will also send you a reminder.

If this request meets this criteria please select your preferred collection date

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