Order Form

We kindly ask that you ensure you know all specific details to fill this form out on behalf of your client. Please note we may not be able to fulfil all items requested but will try our best.

Your Details

Organisation Name*

Full Name*

Email*

(example@example.com)

Phone Number*

(example : 021xxxxxxx | 025xxxxxx | 027xxxxxx | 029xxxxxx)

Client Details

PARENTS FULL NAME or initials for reference NOT CHILDS NAME. (This will be kept confidentially) This is important to us as we need to identify if this client has had an application from another organisation or repeat applications to us. *

How many children is this order for?*

What ethnicity does this family identify as?*

What are the cause/s of disadvantage for this family (you may select more than one )*

Asylum Seeker
Disability
Family reunification
Family violence
Financial hardship
Foster care
Homelessness
Job loss
Kinship care
Mental health
Migrant
Natural disaster
Physical health
Refugee
Single parent
Young mother
Young parent

Which area is the family located in?*

Can you please explain in brief detail this families story and why you are requesting help from Nurturing Families?*

Can we use this de-identified story in our communications? Being able to share stories with no names mentioned enables us to be able to connect with our donors in a way that helps them to keep giving.*

Is this an urgent order?*

Order Details

Is there an unborn baby or children under 2 years of age?

If there is an unborn child, when is the baby due?(Closest approx date)

Please provide the gender (or unknown) in the table below for all babies (including unborn). This allows us to select the most appropriate items.

Baby details

	Age(months)	Gender
Baby 1
Baby 2
Baby 3

Is there any children above 2 years of age?

Please provide the gender in the table below for all children. This allows us to select the most appropriate items.

Children details

	Years	Gender
Children 1
Children 2
Children 3

Is the family in need of a cot or bassinet?

Cot or Bassinet

Please note: We only provide bassinets to newborns to 6 months olds and cots to 6 month + children and Portacot is only to be used for temporary use, ie. in transitional housing. Not to be used for permanent use.

	Quantity required
Bassinet - For a new born - 6 month old
Cot - From 6 months old +
Portacot

If one of the above is needed, please briefly explain why this is needed and/or what the family are using in its place currently?

This is important for us to know, as we have to prioritise our safety items.

Are you requesting a pram?

Prams

Please note: We can only give what's available but will try to fill your request.

	Quantity required
Single
Double

If one of the above is needed, please explain why this is needed and/or what the family are using in its place currently?

This is important for us to know, as we have limited stock of bigger items.

Does the family require a carseat?

Car Seat

Please note: We can only give what's available but will try to fill your request.

	Quantity required
Capsule (newborn)
Convertible (which is used once outgrown capsule,usually 6 month+)
Harnessed Booster (roughly from 2/3 years +)
Unharnessed Booster (roughly for 4/5 years +)

If one of the above is needed, please explain why this is needed and/or what the family are using in its place currently?

This is important for us to know, as we have limited stock of bigger items.

Does the family require nappies?

Nappies

Please only select one size per child.

	Quantity required
Stage 0 - Premmie - 1 - 2.5 kgs
Stage 1 - Newborn - 3 - 5 kgs
Stage 2 - Infant - 4 - 8 kgs
Stage 3 - Crawler - 6 - 11 kgs
Stage 4 - Toddler - 10 - 15 kgs
Stage 5 - Walker - 13 - 18 kgs
Stage 6 - Junior - 16+ kgs
Reusable cloth nappies

Are any other baby product essentials needed?

Baby Product Essentials

We can only give what's available but will try to fill your request.

	Quantity required
Baby Toiletry Pack
Mum Toiletry Pack
Mens Toiletry Pack
Disposable Breast Pads
Reusable Breast Pads
Baby Wipes
Dummies
Baby Bottles (under 12 months)
Formula
Baby Food (4 months - 12 months)
Feeding Items(sippy cup,baby bowl/plate,baby cutlery etc)
Manual Breast Pump (we do not provide electric items)
Breast milk storage bags or containers
Burb cloths

Are any other bedding essentials needed?

Bedding Essentials

We can only give what's available but will try to fill your request.

	Quantity required
Sleep Sacks or Swaddles
Blankets - Below 2 years
Blankets - 3 Years +
Wraps and Muslins
Cot Bedding
Bassinet Bedding
Flannels and Baby Towel

Are any other bigger items needed?

We can only give what's available but will try to fill your request.

	Quantity required
Portable Highchair
Highchair
Breastfeeding Pillow
Microwave Steriliser
Baby Bath
Change Mat
Baby Bag
Play Mat (2 - 6 months)
Front pack/Carrier
Baby Carrier / Baby Sling
Bouncer (0 - 6 months)
Toys (4 - 12 months)
Toys (1 - 5 years)
Toys (6 - 10 years)

Does the family require clothing for unborn babies or children under 2 years of age?

Size	Boy	Girl	Neutral
Premature (00000)
New born (0000)
0-3 months (000)
3 – 6 months (00)
6-12 months (0)
12-18 months (1)
18-24 months (2)

Does this family require clothing for these children?

Children's Clothing

Each size clothing pack will contain enough clothing for one child for both seasons.

Size	Boy	Girl
3
4
5
6
7
8
9/10
11/12

Does the child need shoes?

Please note we might not be able to fulfil all sizes.

Size	Boy	Girl
1/2/3
3/4/5
6/7/8
9/10
11/12/13

Are there any other items or details you would like to add to this request?

If formula has been requested - please state brand and stage needed.

With the release of a fund for extenuating cirumstances, we would like to give you the opportunity to let us know outside of our normal material aid what would truly benefit your families (if there is anything required). These requests will be assessed and not all will be granted but we always want to make sure we are helping in the most impactful way. If this is not applicable just put N/A.

Have you met with your client previously and assessed their need. Can you confirm that they are deemed in hardship or the children are at risk.*

Is there any other feedback you would like to share with us? We would love to hear more about how our service helps you and your clients or anything you feel we can improve on.

Thank you for completing this application on behalf of your client.

Please bear with us while we work on completing this. Please note we may not be able to fulfil everything requested but we will try our best.

We have specific procedures that need to be followed for our warehouse team to work efficiently. This means when you submit an application, you will get a confirmation of what you have submitted via order form. This needs to be kept and printed or saved via phone, to be shown as confirmation when picked up. You also need to be aware that whoever submits the application on behalf of your client or a colleague needs to pick it up on behalf of the client, not the client themselves.

Please note: When the application is ready to be picked up you need to email me back with a time slot given to pick up with your confirmation, otherwise we will not be able to provide you with your items on that day.

If you have any questions or queries, please contact us via email, info@nurturingfamilies.nz