BABY BANK KENSINGTON AND CHELSEA          REFERRAL FORM
The Baby Bank Kensington & Chelsea  has been established to provide short term, emergency support to families in crisis/affected by COVID19. This service applies to families with children up to the age of 3.
Please make an appointment by calling our freephone number: 0800 047 8161 to arrange a time to collect your essentials.
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Do you live in Kensington & Chelsea? *
What is your full name? *
What is your full address? *
Please leave a number/email address for us to contact you *
How many children are you responsible for and what ages are they? *
Please state reason for referral (tick all that applies)
What do you require? e.g nappies size 2, formula 1-1 years... please also state any allergies/dietary requirement
If you have used the Baby Bank before, please tell us when you last visited *
Please indicate if there are any special needs/requirements in the household
We need your consent to be referred to the Baby Bank. Please confirm by ticking the box below
We are committed to protecting your personal information and respecting your privacy. We are only collecting your information for the purpose of accessing the Baby Bank.                                                    For our full privacy policy please Visit our website:  https://www.214space.org                                                                               If you would like to get updates about the SPACE services please give your email below                                                                                                                                                      
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