This guide helps when you use our online order from.
Please note to access our services all social workers and maternal and child health nurses must be registered with Eureka Mums.
If you are not yet registered, please register here prior to completing this form.
Please ensure that you complete one request form for each family.
For further assistance or for emergency requests, please contact the Social Services Coordinator via email.
Q: Your name?
Please enter your full name including first name and surname. If your organisation does not allow you to disclose your surname, please include your first name only.
Q: Your organisation?
Please enter your organisation’s full name, do not put acronyms. If your organisation is Victoria wide, please include your organisation and the suburb it’s located, e.g. SalvoConnect – Ballarat
Please enter the work email you used at registration - if you do not use your registered email address the form will not submit properly.
Q: Your mobile number?
Please enter your work mobile number in full. If you do not have a mobile number please enter your work’s main office number.
Q: Mother’s initials or reference (to prevent duplication of orders)
Please enter the initials for the mother of the child and/or children. In the absence of a mother, please enter the details of the guardian, carer or father. This collection of personal information will be stored securely as required under the Australian Privacy Act. This is important for us to detect and prevent duplication of orders.
Q: What Local Government Area (LGA) does the family reside in?
Please click on the text box and choose LGA.
Q: Does this family identify as Aboriginal or Torres Strait Islander?
Click on the text box and select the correct option.
Q: What are the causes of disadvantage for this family (you may select multiple items by holding down your Ctrl or command key on your keyboard)
Please click on the text box, select the cause from the list available. You may select more than one by holding down your Ctrl or command key on your keyboard.If you have selected ‘other’ can you please use the further notes or comments box at the end of this form just before you submit. In this box you can provide another cause for disadvantage.
Q: Does the family have a Health Care Card?
Please select Yes or No. This does not effect eligibility for our service.
Q: Is this family connected with other support services, if so who?
Please enter the other service(s) that this family is supported by. For example, Child Protection might also be supporting this family.
Q: What is the due date of baby or birth date of the of the youngest child? (Please write dd/mm/yyyy)
Please enter the day, month and year of the due date or the birth date of the youngest child in the family. Please ensure that it is entered in the format as requested above.
Q: Baby’s gender?
Please select what applies to this youngest child. If there are twins, please select twins and let us know the gender of them in the further notes or comments box located at the end of this form.
Q: As of today, how many babies does this family have that are younger than 12 months (including the one(s) due)?
Please enter the number of babies, under 12 months of age in this family. This is to also include any babies yet to be born. For example there are two babies (twins) 11 months old, mum is eight weeks pregnant. So please enter three babies.
Q: How many children are there in total in this family? (please include baby or babies due to be born)
Please enter the total number of babies (under 12 months of age) and children in this family you are requesting for. For example, mum is 11 weeks pregnant; there is a two-year-old boy, seven year old girl and 12 year old girl. Please enter four children.
Q: What are the age(s) and gender of the older siblings? (Please write G5, B6, etc)
Please enter the age and gender of children (older than 12 months) for the family you are requesting for. For example if there is a 1 year-old boy and three year-old girl please enter – B1 and G3. If there are no other children please write N/A (this is a required field)
Q: Does the family need a cot?
Please click and select what your family needs.
Q: What type of pram would you like to request? (please choose one)
Please click on the text box and select the appropriate pram for this family.
Q: What car restraints do they need? (you may select multiple items by holding your Ctrl or Command key on your keyboard)
Please click on the text box and select the correct car restraint for the baby, child or children. If the family needs more than one of the same car restraint type, please detail this in the further notes or comments box located at the end of the form.
It is the law for all children up to the age of 7 to be in a child restraint or booster seat when travelling in a vehicle. Choosing the right child restraint for a child will depend on their age and size.
To keep a child safe, the restraint must also be properly adjusted, fastened, and fitted to the vehicle. More information is available from the Vic Roads website. All Eureka Mums car restraints have tether strap.
Q: What other items would you like to request? (you may select multiple items by holding down your Ctrl or Command key)
Please click in text box, select the items that the children and/or parents/carers require. Please note that you can select multiple items in the text box as by using your Ctrl or Command key.
If you select bottle and breastfeeding kits please tell us which one you require in the further notes or comments box located at the end of this form. This also applies to formula (stages), nappies (sizes), toiletries (male/female/baby).
Please note that the nappy sizes listed below are a guide only, so to ensure the correct size(s) is provided please obtain accurate sizing from your families
- Newborn (up to 4kg)
- Infant (4 to 8kg)
- Crawler (6 to 11kg)
- Toddler (10 to 15kg)
- Walker (14 to 18kg)
- Junior (16kg+)
We also have Night Pants available for older children:
- 4 - 7 years old
- 8 - 15 years old
Q: What clothing bags do they need? (you may select multiple items by holding your Ctrl or Command key)
Please click on the text box, select clothing required for each baby and/or child. For example, G4-5 means girls size four and five and B7-8 is boys size 7 and 8. You can select multiple clothing bags by using your Ctrl or Command key on your keyboard.
Q: What sized linen or bedding do they need? (you may select multiple items by holding your Ctrl or Command key)
Please click on the text box, select the appropriate bedding for the baby and/or child. Please note that cot as well as single bed linen can be requested here. Eureka Mums also provides unisex cot linen if the gender of the baby is unknown.
Q: Do you have any further notes or comments about this request?
Please click on this text box to enter any further information you can provide about your request or for any additional needs.
Q: Please confirm that you agree with the terms of our Service Policy?
Please read our Service Policy if you haven’t already and click on the text box to select Yes.