Lover Baby Bank (charity number 1204744) Referral Form

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PLEASE READ IN FULL BEFORE COMPLETING A REFERRAL

Please complete this form if you are a professional wishing to request items for a family in financial struggle or are unable to obtain these items for themselves.

We invite referrals from all agencies and organisations that are in contact with vulnerable families to make sure that their babies’ basic needs are met.

We cover the following postcode areas - SP1, SP2, SP5, SP6, BH24. If your service user lives outside of these post code areas, please contact us via email to enquire as we may still be able to help.

All items are given to recipients free of charge. If the referral is for an unborn baby, please refer from 28 weeks of pregnancy so that we can prioritise stock for imminent arrivals and urgent requests.

We unfortunately are unable to offer a delivery service, this will need to be considered when making a referral. In exceptional circumstances it may be possible, please discuss your requirements with us. We are located south of Salisbury, near Downton.

If you are able to obtain items/equipment from any other source or through funding elsewhere, please explore this option before referring to us. We are a very small charity and do not always have items readily available or funds.

Lover Baby Bank does not typically have any direct contact with families themselves, and we do not collect any identifying information about them.

If you are a family in need of help and would like to be referred to Lover Baby Bank, please if possible contact your health visitor, GP, midwife, family nurse, social worker, local children’s centre, citizens advice or other similar organisation to support your referral.

Please feel free to contact us if you are unsure of where to turn for support and advice.

We are happy to signpost any families in need towards further support.

If you have any queries, please contact us at admin@loverbabybank.co.uk

Email *

Your organisation name/business/name *

Your role *

Midwife

Health Visitor

Education Leader

Religious Leader

Family Support Worker

Social Worker

Family Nurse Partnership

Foodbank Volunteer

Other:

Phone number *

Please tick to show you are happy for us to store these details electronically in order to contact you about this referral -
*

Yes

No (Data will be destroyed after donation process is completed)

Required

INITIALS ONLY of family/individual *

Where does the service user live? (area only) *

Please indicate the ethnicity of the child / children:
*

Who lives in the family home with the child / children?

This helps us to personalise bundles where we can, for example mum, dad, older siblings etc.

Please indicate the age and gender of the child / children (or estimated due date)

Reason for the referral:
*

Please confirm whether you or a colleague are able to collect from us in Lover or arrange a suitable drop-off point?

This allows us to maintain the privacy of the family and their identity remains confidential.

How soon are these items required?

Please note: requests are subject to the items we have available at any one time.

Please indicate which items are needed -

We cannot guarantee that we will be able to supply everything requested, however we will endeavour to do our very best for the families and offer a suitable alternative where appropriate.

Mum-To-Be toiletry bundle (toiletries, maternity pads, breast pads, other items if in stock)

New Baby Bundle in Moses basket/crib - includes items such as clothing, bedding, bottles (new teats), wipes, nappies, baby toiletries along with a moses basket or crib with new mattress)

Moses basket plus new mattress

Crib (for newborn) plus new mattress

Cot

Bedding - specify size in additional information

Pram/Pushchair (please specify below age of child e.g from birth)

Sling/Baby Carrier

Bottles including new teats

Breast Pump (this may not be available as need to be purchased brand new)

Clothing (specify size/gender in notes below, currently we only keep for newborn-1yr approx)

Muslins

Nappies/Wipes

Travel cot

Nappy change bag

Change mat

Toiletries (baby, family - please specify below)

Play Mat

Safety Gate

Baby chair/Bouncer

Toys (currently only baby toys)

Highchair

Baby bath/Bath seat

Steriliser (specify if can be microwave, or cold water)

Feeding pillow

Other:

Is there any extra information we might need to know about the items required? Or anything needed that is not listed above?

E.g. The age range of clothing needed, gender, shoe size, nappy size etc.

We would like to contact you with updates on our progress, services and charity events available to you and the families you support. Please indicate whether you are happy for us to keep you updated via our newsletter, or if you'd prefer us not to.
*

Yes please, I’d like to hear from Lover Baby Bank

No thank you, I would not like to hear from Lover Baby Bank

Where did you hear about us?

Please indicate you will read and accept our terms and conditions - A copy of the terms and conditions can be found on our website

Yes, I have read, understand and agree to Lover Baby Bank's Terms and Conditions

I have some questions - please email queries to admin@loverbabybank.co.uk

Other:

Today's date *

YYYY

A copy of your responses will be emailed to the address you provided.

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