Service User Order Form

Roundabout Canberra welcomes orders from social service agencies, health services and community organisations working to support families, children and young people. All orders must be collected or delievered to your service. If you are an individual needing help, please visit our Get Help page.

Your First Name

Your Last Name

Your Email

(example@example.com)

Your Mobile/Phone Number

(example: 04xxxxxxxx or 02xxxxxxxx)

Your Organisation's Name (no abbreviations please)

I can't find my organisation in the list

Enter Your Organisation Name

Parent or guardian's full name or reference (this will be kept confidential)

Does anyone in the family identify as Aboriginal and/or Torres Strait Islander?

What circumstances are relevant for this family? (you may select more than one)

Asylum seeker / refugeeCarer (e.g. kinship/foster/partner care)Child protection issuesCulturally and linguistically diverseDisability (child and/or parent)Domestic violenceFinancial hardshipHousing Issues / HomelessIsolation, lack of supportMental health issues (child and/or parent)Multiple birthPhysical health issues,eg.illness)Single fatherSingle motherSubstance abuse issuesYoung parent/s (under 25)

Which best describes the current employment circumstances of the parent/s or caregiver/s in this family? Employed includes full-time, part-time, casual and self-employment.

Which residential area is the family located in (ACT or NSW)?

If you can't find the local government area above, please tell us where the family resides:

Please tell us more about this family's story that may assist us in preparing items

May we use this de-identified story in our communication?

Is there an unborn baby or child/ren under 2 years of age?

What is the due date or the birthdate of the youngest child in this family?

Baby Details

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

Baby Details

Baby 1 Age(months)

Baby 2 Age(months)

Baby 3 Age(months)

Baby 1 Gender

Baby 2 Gender

Baby 3 Gender

Does the family require clothing for the baby/babies?

Baby Clothing

Larger sizes 2-16 are included on the next page of this form. Each size clothing pack will contain enough clothing for one child for a season. One pack per child is enough clothes for one year please select a quantity of 1 per child.

Unisex

Newborn to 3 months - summer (size 0000 and 000)

Newborn to 3 months - winter (size 0000 and 000)

Boy/Girl Clothing

Boy

Premature (size 00000)

Newborn to 3 months - summer (size 0000 and 000)

Newborn to 3 months - winter (size 0000 and 000)

3 – 6 months – summer (size 00)

3 – 6 months - winter (size 00)

6-12 months - summer (size 0)

6-12 months - winter (size 0)

12-18 months - all seasons (size 1)

18months -2years - all seasons(size 2)

Girl

Premature (size 00000)

Newborn to 3 months - summer (size 0000 and 000)

Newborn to 3 months - winter (size 0000 and 000)

3 – 6 months – summer (size 00)

3 – 6 months - winter (size 00)

6-12 months - summer (size 0)

6-12 months - winter (size 0)

12-18 months - all seasons (size 1)

18months -2years - all seasons(size 2)

Does the family need a cot or bassinet for a baby?

Safe Sleeping

We are unable to provide both a cot and a bassinet for one child due to high demand and waitlists. If the family has twins, you can request two. 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.

Cot

Bassinet

Please confirm that the recipient does have the ability and resources to follow written assembly instructions. If they don’t, please confirm that you will help them, or arrange for someone to help them, install and use the items correctly.

Yes, I will ensure the recipient can assemble and install items correctly.

We provide essential items for children up to 16 years old. Does the family have any children aged 2 to 16 years old requiring items?

Children Details

Please provide the gender in the table below for all children so we can select the most appropriate items. If you require neutral items for a client, you can note this in the comments at the end of the form.

Child 1 Age

Child 2 Age

Child 3 Age

Child 4 Age

Child 5 Age

Child 6 Age

Child 1 Gender

Child 2 Gender

Child 3 Gender

Child 4 Gender

Child 5 Gender

Child 6 Gender

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 (winter and summer). One pack per child is enough clothes for one year. Please select a quantity of 1 per child.

Boy size - 1

Boy size - 2

Boy size - 3

Boy size - 4

Boy size - 5

Boy size - 6

Boy size - 7

Boy size - 8

Boy size - 9

Boy size - 10

Boy size - 12

Boy size - 14

Boy size - 16

Girl size - 1

Girl size - 2

Girl size - 3

Girl size - 4

Girl size - 5

Girl size - 6

Girl size - 7

Girl size - 8

Girl size - 9

Girl size - 10

Girl size - 12

Girl size - 14

Girl size - 16

Is there a specific information we need to know about clothing for these children?

Does the family require a pram?

Prams

Newborn Pram

Pram 6mth+

Double Pram

If a double pram has been requested, please provide the children's weights. Please also let us know whether the family lives up a flight of stairs, and whether they need a side-by-side or tandem pram.

Does the family require car seats?

Car Seats

All car seats come with a copy of the relevant installation manual and voucher for free professional installation at Kidsafe ACT.

Capsule (0-6m)

Newborn (0-4 years)

Forward facing (2 years +)

Booster (5 years +)

Please confirm that you will advise your client to follow the provided instructions on installing the car seat correctly, and encourage them to utilise the Kidsafe ACT voucher provided (for those within the ACT region).

Does the family require linen packs?

Linen

Packs include age-appropriate sheet sets, mattress protectors, blankets, bath towels, and face cloths. Single bed packs also include doona and pillow.

Bassinet - Boy

Bassinet - Girl

Bassinet - Unisex

Cot - Boy

Cot - Girl

Cot - Unisex

Single bed - Boy

Single bed - Girl

Sleeping swaddles/sacks - newborn to 1 year

Sleeping suits/bags - age 1-3 years

Does the family require any feeding items?

Feeding Items

Please note that we may have breast pumps (manual and electric) available on request. You can add this in the comments at the end of the form.

Breastfeeding pillow

Breastfeeding pack

Bottle feeding pack (includes steriliser)

Formula

Steriliser

Feeding pack (age 4-12 months)

Feeding pack (age 12 months +)

Does the family require nappies?

Nappies

Please select 1 pack per baby/child, as each pack contains approx. 100 nappies.

Nappy bag (bag to hold baby items when out)

Wipes

Premmie

Newborn (1) - up to 5 kg

Infant (2) - 4 - 8 kg

Crawler (3) - 6 - 11 kg

Toddler (4) - 10 - 15 kg

Walker (5) - 13 - 18 kg

Junior (6) - 16 kg +

Nigh-time nappies - 4 years +

Does the family require toiletry packs?

Toiletries

Please only add one toiletry pack per family member.

Baby

Children's - 3 to 10 years

Teens - 11 years +

Maternity

General Items

Please note that we may have safety gates and playpens available on request. You can add this to the comments at the end of the form.

GeneralItems

Baby bath

Baby carrier

Bouncer / Rocker

Change table

Safety pack (household safety items, e.g. powerpoint covers)

Highchair

Does the family require school packs?

School Packs

Includes stationery, lunchbox and drink bottle.

Childcare

Preschool/Kindy - age 4 - 6 years

School bag - age 6 - 9 years

School bag - age 10 years +

Does the family require toy packs?

Toys

0 - 18 months - Unisex

0 - 18 months - Boy

0 - 18 months - Girl

18 months - 3 years - Boy

18 months - 3 years - Girl

3 - 5 years - Boy

3 - 5 years - Girl

6 - 9 years Boy

6 - 9 years Girl

10 years + - Boy

10 years + - Girl

Baby Activity Mat

Activity Mat - Unisex

Activity Mat - Boy

Activity Mat - Girl

Does the family require book packs?

Book Packs (age appropriate reading books)

0 - 18 months - Baby

18 months - 3 years - Toddler

3 - 5 years - Preschool

6 - 9 years - young school age

10 years + - Older school age

Does the family require Christmas Gifts?

Please let us know how many children aged 0-16 require a Christmas gift

Please let us know any details about likes or dislikes when selecting gifts

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

Please indicate which day you are available to collect or receive your order, allowing 48 hours for us to prepare the stock for your request, allowing 48 hours for us to prepare the stock for your order. We are open for collections 9:00am - 3:00pm (closed ACT public holidays) and by appointment only at other times. Delivery days are detailed below.

We offer free delivery to your organisation by region on a first-come, first-served basis, as availability is limited.

Monday - Queanbeyan and East Canberra (Majura, Hume) 9:30 am-11:30 am

Tuesday - South Canberra (Woden, Weston, Tuggeranong) 11:00 am-3:00 pm

Wednesday - Central Canberra (Civic, Inner North and Inner South) 9:30 am-11:30 am

Thursday - North Canberra (Gungahlin and Belconnen) 9:30 am-11:30 am

Surrounding NSW towns on request.

You must have someone available at your service to accept the items during the above times. Unfortunately, we cannot deliver to families or individuals. If you would like delivery, please indicate this below with full address details and drop off information.

We need at least 48 hours notice and will let you know if we cannot facilitate delivery due to demand.

Yes, I would like request for delivery.

Delivery address for your organisation:

Search Address

Street

City

State

Postcode

Country

Delivery phone contact or any instructions for our driver for the day of delivery in case we have trouble locating you:

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