Baby Bank Request Form

Name: Baby Bank & Beyond CIC
Address: Hellingly
Telephone: 07355 445502

1. Referrer Details

2. Family Details

Please tick all that apply (this information is for funding purposes):

3. Items Requested

4. Additional Information

Name*

This field is mandatory

Organisation

Contact Number*

This field is mandatory

E-mail*

This field is mandatory

The e-mail address is invalid

Parent / Carer Name*

This field is mandatory

Family Address*

This field is mandatory

Children (please include Name, Age and Gender):*

This field is mandatory

Seeking asylum / Refugee

Young parent (16–25)

Cost of living

Mental Health Issues

Affected by domestic abuse

Victim of trafficking

Homeless

Other

If 'Other', please specify:

Please list the items required (clothing with sizes, toys, cot, highchair, bedding etc). If the items are for an expected new arrival, please specify gender if known and baby’s due date.*

This field is mandatory

If you can provide any other information that may help us to make up this bundle (requests, likes / dislikes etc). If we can accommodate these we will:

* Indicates required fields

There was an error submitting your message. Please try again.

Thank you! We will get back to you as soon as possible.

Confidentiality

All requests are treated in the strictest confidence.

Once the bundle is ready, we will email you to let you know.

Referrals need to be collected from our Hellingly base by you or a team member and NOT the family, and

collection (by agreement) should be made within 10 days.

We can deliver larger items like cots and prams within the South Wealden, Eastbourne, Lewes and Seaford area.

If you are unable to transport them yourself – just let us know.

If we are delivering to the family on your behalf we need to be fully aware of any known risks.

This form does not correctly format on mobile devices. To ensure we receive the correct information, we recommend filling the request form in using a tablet or desktop.