Request form special campaigns

Order Form

Welcome to the online request form for Eureka Mums. 

Eureka Mums provides this service via registered health professionals. If you are a parent, carer, guardian, relative, friend, foster or kinship carer, please ask your social worker or maternal child health nurse to place an order on your behalf. Please see this page of our website for more information. 

We are still working hard to help as many families as we can despite restrictions due to COVID-19. Some items are in low supply. We will do our best to fill your order as completely as possible.





Confirmation & Service Policy Agreement
To access our service you must be a Maternal and Child Health Nurse or a social worker with a registered social service or welfare agency. We have a waitlist for larger in-demand items such as cots, car restraints and prams but have a constant supply of clothing bags, toys and books and other nursery items. Please take the time to read our Service Policy. Please do not bring your clients with you when you meet with us.

This form is to be used for special campaigns where you ask for certain items for multiple families, like "back to school", "one mother to another", etc.

All fields with * are mandatory and must be completed. 

Your Details








i.e. 0412345678

i.e. 0312345678
Family Information









Please enter N/A or Not Known if you don't know if or who else is supporting this family.
The Children

i.e. Please enter 2 if the family is expecting twins, or 3 if the family is expecting twins and already have a baby under 12 months of age. Enter 0 if there is no baby.


Items

Please enter a number here

Please enter a number here

Bulk Order Only

Comments and Notes
Please add any other final comments or notes about this request here. Please note we rely on donations, so we cannot guarantee supply of everything but we'll do our best.

Delivery will be either to your office or to a freight depot nearby. Please provide delivery address (items will never be delivered directly to your client)*
Opening Times
Our opening hours for collections are: Tuesday and Thursdays 10am - 12pm.

You can choose a date in the next 90 days.

For further assistance or for emergency requests, please contact the Social Services Coordinator via email.
Eureka Mums provides this service via registered health professionals. If you are a parent, carer, guardian, relative, friend, foster or kinship carer, please ask your social worker or maternal child health nurse to place an order on your behalf. Please see this page of our website for more information. 

Contact Our Service Team