BABY BANK REQUEST FORM

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

Name*

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Organisation

Contact Number*

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E-mail*

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The e-mail address is invalid

Parent / Carer Name*

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Family Address*

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

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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.*

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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:

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

* Indicates required fields

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

Professional Referral:

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

Professional referrals need to be collected from our Hellingly base by you or a team member and NOT the family. Collection (by agreement) should be made within 10 days. If you are unable to transport larger items like prams and cots, please let us know.

Self Referral:

YOU ARE WELCOME TO SELF REFER BUT PLEASE NOTE, WW ONLY COVER HEATHFIELD, HAILSHAM, POLEGATE, EASTBOURNE, LEWES & NEARBY VILLAGES IN EAST SUSSEX

We do not have premises for collection by families direct.