Client Referral for Kindness Request
What organisation are you affiliated with?
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What is your name (first and last)?
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What is your job title?
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What is your phone number?
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Your Email Address
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Let us know what date you prefer to pick up donated items from ProjectKindness for your client.
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Day
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Month
Year
IMPORTANT - Please ensure you choose one of the following days: Tuesday 12:30-1:30pm from our Alexandria base, Wednesday: 2:30pm-3:30pm from our Alexandria base, or Thursday: 4:30pm from our outreach in Waterloo.
Let us know what time you prefer to pick up donated items from ProjectKindness for your client.
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IMPORTANT - Please ensure you choose one of the following days: Tuesday 12:30-1:30pm from our Alexandria base, Wednesday: 2:30pm-3:30pm from our Alexandria base, or Thursday: 4:30pm from our outreach in Waterloo.
AM
PM
AM/PM Option
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Your Client's Details
What is your client's first name?
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What is your client's last name?
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What is your client's date of birth?
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Day
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Month
Year
What is your client's postcode?
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What is your client's gender?
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Female
Male
Non-binary
Prefer not to say
Other
Is your client of Aboriginal and/or Torres Strait Islander descent?
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Yes
No
Unsure
Does your client identify as culturally or linguistically diverse?
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Yes
No
Unsure
What is your client's current family situation?
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Please note any family dependants and/or partner here. Please ensure that if there are children in the family and the hamper request includes toys or books, you note each child's gender and age here. This helps us personalise the hamper to best suit the family's needs.
Are there any sensitivities regarding your client with regard to the items we are providing which we should be aware of?
ProjectKindness cares deeply about every referral and is committed to approaching each one with sensitivity and care.
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Your Kindness Request
What kind of items would help your client most at this point in time? Please note that ProjectKindness offers no further items outside of list below.
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Baby Essentials (blanket, toys, books)
Blankets
Cot Bedding (fitted sheet, baby blanket)
Cups & Glasses
Cutlery
Baby Clothing - Please note that ProjectKindness provides clothing for babies / infants only, with sizes ranging from 0000 to size 3.
Children’s Toys and Books - Please ensure that the ages and genders of the children are listed above.
Double Bedding (Fitted Sheet, Quilt Inner, Quilt Cover)
Kettle
King Single Bedding (Fitted Sheet, Quilt Inner, Quilt Cover)
Non-perishable Groceries - Please note that all of our food is generously donated, so we're unable to accommodate specific allergies or food preferences.
Plates & Bowls
Pots & Pans
Queen Bedding (Fitted Sheet, Quilt Inner, Quilt Cover)
Single Bedding (Fitted Sheet, Quilt Inner, Quilt Cover)
Toaster
Towels
How many babies / infants, if any, need clothing as a part of this Kindness request?Please note that ProjectKindness provides clothing for babies / infants only, with sizes ranging from 0000 to size 3.
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No babies / infants
1
2
3
4
What is the baby / infants gender?
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Boy
Girl
Undefined gender
What is the gender of baby / infant?
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Boy
Girl
Undefined gender
What is the baby / infant's clothing size?
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Size 0000
Size 000
Size 00
Size 0
Size 1
Size 2
Size 3
What is the clothing size of baby / infant 1?
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Size 0000
Size 000
Size 00
Size 0
Size 1
Size 2
Size 3
What is the gender of baby / infant 2?
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Boy
Girl
Undefined gender
What is the clothing size of baby / infant 2?
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Size 0000
Size 000
Size 00
Size 0
Size 1
Size 2
Size 3
What is the gender of baby / infant 3?
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Boy
Girl
Undefined gender
What is the clothing size of baby / infant 3?
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Size 0000
Size 000
Size 00
Size 0
Size 1
Size 2
Size 3
What is the gender of baby / infant 4?
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Boy
Girl
Undefined gender
What is the clothing size of baby / infant 4?
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Size 0000
Size 000
Size 00
Size 0
Size 1
Size 2
Size 3
How did you hear about ProjectKindness?
Colleague
Social Media
Ask Izzy
Google Search
Other
At ProjectKindness, we love to keep our supporters and followers informed about the impact of their generosity. With your permission, may we share a brief, de-identified background of your client? This would not include any names, specific details, or your workplace information.
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Yes
No
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