Request form

Thanks for visiting Eureka Mums!

To access our services all caseworkers, 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 note, complete one form for each family you are requesting for. For helpful hints on how to complete this form please click here.   

For further assistance or for emergency requests, please contact the Social Services Coordinator via email 

We look forward to receiving your request soon - thank you for your support of families in need.

Your Details

Your name *

Your organisation *

Email *

Your mobile number *

Family Information

Mother's initials or reference (to prevent duplication of orders)*

What Local Government Area does the family reside in? *

Does this family identify as Aboriginal or Torres Strait Islander? *

Does the family have a health care card? *

What are the causes of disadvantage for this family *

You may select multiple items by holding down your Ctrl or command key. If you chose 'other', please detail it here

Is DHHS involved with this family/child?*

Is this family connected with other support services? If so, who?

What is the due date or birthday of the baby or the birth date of the youngest child? (Please write dd/mm/yyyy) *

Baby's gender *

How many children are in the family in total? *

How many are we directly supporting with this request (including babies due to be born)?   *

How many are younger than 12 months (including the one(s) due)? *

What is the age(s) and gender of the older siblings? (Please write G5, B6 etc.)

Items Required

Cot or bassinet: Please note that cots are recommended from birth, and bassinets only last until the baby can roll, which can be as young as 10 weeks

Does the family require a cot? If so, please enter 1 here (2 for twins)

Does the family require a bassinet? If so, please enter 1 here (2 for twins)

If the family has a cot in good condition that complies with the current regulation and only needs a mattress, please enter 1 here , specify the details of the cot on notes and specify the required mattress size here  (length, width and height). You should find these measurements on the base of the cot.

 

Pram: Does the family require one? If so, please enter 1 next to the type (one pram only) 

Single Pram:
Stacker/Tandem Pram:
Side by Side Double Pram:
We try to match the best pram for the family, please indicate if they have a car or they rely on public transport and/or any details relevant for pram/stroller selection.

If the family needs a multiples pram please enter 1 and we will contact you to confirm the most suitable solution.
Triple: Quad:

 

Car Restraint: Does the family require one? If so, please enter 1 next to the type. If you need more than one car restraint (for siblings or multiples) please enter the relevant number next to the type.

Capsule (rear facing for infant):
Reversible (rear and front facing):
Toddler (front facing with harness):
Booster (front facing, no harness): 

Nappies: If the family needs nappies, please enter the number of children you are requesting nappies for here  and specify the sizes here .

 

Other Items: Please enter 1 next to any required items. Please note we rely on donations, so we cannot guarantee supply but we'll do our best.

Please enter 1 next to the following items in case the family would need any. If they need more than one please enter the number but remember that many items come in packs or kits. Baby Front Carrier:
Bath:
Breast Feeding Kit (inc. manual breast pump, only available once baby is born): 
Breast Feeding Pillow:
Bottles (only available once baby is born):
Bouncer:
Breast or Maternity Pads Pack:
Change Table:
Change Mat:
Coats:
First Food Kit (utensils and equipment):
Formula (only available once baby is born):
Highchair:
Cloth Nappies:
Nappy Bag:
Playpen:
Safety Kit (drawer/cupboard locks, power point covers etc):
Safety Gate:
Sterilizer:
Toddler Bed:
Toiletries Pack: If so, please specify here 
(Baby, Adult Female, Adult Male, Children)
Toys Bags/Activity Mats/Books & Puzzle Bags:
Wipes:

  

If they need clothes, enter the number of clothing bags they need. 

 Size   Boy  Girl
 UniPrem: 
Prem     
Birth-1    
1-2    
2-3
3-4
4-5
5-6
7-8
9-10
11-12
13-14
15-16

 

If they need shoes, enter the number of bags per size they need (C = child, Y = youth), there are approximately 4 pairs of shoes per bag

 Size   Boy  Girl
C5
C6
C7
C8
C9
C10
C11
C12
C13
Y1
Y2
Y3
Y4
Y5


If they need linen, enter the number of linen or bedding bags they need.  

 Cot Boy:   Single Bed Boy:   Bassinet Boy: 
 Cot Girl:   Single Bed Girl:   Bassinet Girl: 
 Cot Unisex:     Bassinet Unisex: 
Do you have any special requests, further notes or comments about this request?

Please confirm that you agree with the terms of our Service Policy? *

 

Opening Times

Our opening hours for collections are: Wednesdays 1:30 - 2:30 pm, Tuesday and Thursdays 10 - 11 am.

Criteria for collection:

  • Pick up must be at least 5 business days from date of order. This is to give us enough time to prepare stock for you.
  • Clients must be 6 months or 28 weeks pregnant to book a pick up date.  If you are ordering before your client is 28 weeks pregnant you will need to email us closer to the due date to schedule collection. We will also send you a reminder. 

 If this order meets this criteria please select your preferred collection date

Looking forward to receiving your request soon - thank you for your support of families in need.