Referral Form

About You

Your Name (required)
Your Email (required)
Your Agency/Organisation (required)
Your Phone Number (required)
Your Agency/Organisation Address
(if this is your first contact)

About Your Client

Please tick to indicate whether your client is
 a pregnant woman a baby (0-18 months) a young child (1.5-3 years)

Equipment Desired

Safety Equipment
 Stairgate

Feeding Equipment
 Steriliser Bottles Breastfeeding Equipment Highchair Feeding Cushion

Bathing & Washing Equipment
 Baby Bath Potty Changing Mat Disposable Nappies Reusable Cloth Nappies Towels

Sleeping Equipment
 Cot/ Cot Bed Travel Cot Moses Basket Baby Bouncer Sheets Towels Blankets

Travel Equipment
 Stroller Pushchair Single Pram Double Pram/ Buggy Travel System Baby Carrier

Additional Requirements/Notes

Terms and Conditions

Most of the items we can supply to you have been donated to us second-hand and accepted in good faith. Little Lambs cannot guarantee the reliability or safety of any items and we strongly recommend that you remind your clients to thoroughly check and clean all items themselves before use. I understand and agree 

And Finally

To prevent abuse of this form, please prove you are human: