Moonstones Referral form
At Moonstones we understand how difficult it can be to have to start all over again. We hope that the items we offer can help to take some of that worry away from you by providing the following support. 

Our essential care packages for temporary accommodation, i.e. hostels/hotels and fresh start packs for other accommodation, should hopefully relieve some of that pressure for you. 

We work on a 'referral only' basis, unfortunately we are unable to accept private referrals. Therefore you  will need to ask an organisation/service to refer you to us.  (Please note that the return email address on this form is for referrals only, therefore it is not monitored for information or enquiries.)
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Email *
Referrer's Name *
Company/organisation and job role *
Mobile number *
Family's name. 
(If this is not available, then the postcode for the property). 
 *
Do you need us to provide for any children? *
Required
If yes, please provide the number of children you have, and their age and gender
Bedding packs
Our bedding packs consist of the following. Duvet, sheet, duvet cover set, pillows, mattress protector and a fleece blanket.  If you would like child themed sets, select the option below and then in 'other' state if the young person is a boy or a girl and their age. Use this option also if more than one single pack is required.
Towel bales
We offer two different sized towel bales. Each one comprises of face cloths, hand towels and bath towels. The small bale has 2 face cloths, 2 hand towels and 2 bath towels. The large has 2 face cloths, 4 hand towels and 4 bath towels. We ask that you are mindful and order accordingly to the size of the family.
Toiletry packs
Our toiletry packs include shampoo, conditioner, shower gel, make-up wipes, sanitary pack, toothbrush, toothpaste, hand wash and toilet rolls. We can provide children's toiletries if required. These will be basic items. 
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