Referral Form

Page 1

Welcome to Stripey Stork's referral form.

Please complete the form - there are four pages - adding a new section for each household member. You can add the items needed for each individual, adding up to a maximum of thirty different items.

If you would like to refer more than one family, please ensure you complete this form and click Submit before completing a new form.

If you have any queries, please contact refer@stripeystork.org.uk.

And for further information about how we use your data, please click here.

Do you agree to our referral policy? (located here)

Referral policy - please read

If you are unable to agree to our referral policy we cannot process your referral further. Please contact info@stripeystork.org.uk for further information

Your Details

Please select your type of organisation and then the name of the organisation. If you are unable to find your organisation name, please select NOT LISTED and complete the following questions.

Type of organisation

Organisation

Organisation name

Team

Your first name

Your surname

Your email address

Your mobile number

Postcode of your work address

We collect geographical information to derive the areas where our service is most needed and used. We store this data securely, and take measures to prevent it from being disclosed to third parties. The data is collected via our referral partners, and is only used in aggregated form to assess the impact of our work. The system we are using to manage referrals data is Salesforce, the world’s #1 cloud-based CRM system. It has robust data security measures in place. You can find out more about how Salesforce protects your data here (https://trust.salesforce.com/en/).

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Please complete a request for each item, click on Request another item to add further items.

Items - complete for each item

Page 4

Last few bits and pieces

Book a collection slot or arrange a delivery

Delivery

You have selected a delivery slot, and you will be sent an email with a link to our delivery slot booking page, when you have submitted this form.

Please let us know where you would like your referral to be delivered to in the comments box.

We have existing delivery hub arrangements with specific referrers and can currently only accept delivery requests where these arrangements already exist. If collecting would prevent you from referring and/or you think you may be able to act as a delivery hub please do contact us to discuss this further.

Please note we are unable to delivery directly to families.

If you do not have a delivery arrangement with us, please contact us at refer@stripeystork.org.uk to enquire.

Delivery slots are limited and we cannot guarantee availability.

Collection

You have selected a collection slot, and you will be sent an email with a link to our collection slot booking page, when you have submitted this form.

Please note that if you have selected only school items, you will be sent an email with a link to book a collection slot at Raven House, a different location from our usual Reigate site. You can only book a collection slot from Raven House for these types of referral.

Please add any other notes, requests or comments

Join our Referrals Mailing List to receive essential updates about our service and
how to refer for our campaigns

If you have another referral for a different household to make, make sure you submit this form first, then start the process again refreshing your screen.

Please note that all referrals will need to be collected by the referral organisation.

Stripey Stork Referral Form

Page 1

Page 2

Please provide information about the household and individual family members. Click on add another household member to add more.

Page 3

Please complete a request for each item, click on Request another item to add further items.

Page 4

Help with using the referral form

Join the Stripey Stork mailing list

Stripey Stork - Family Support. Recycled

Site Links

Our Policies

Other Baby Banks

Referral form

Please note that all referrals will need to be collected by the referral organisation.

Stripey Stork Referral Form

Page 1

Page 2Please provide information about the household and individual family members. Click on add another household member to add more.

Page 3Please complete a request for each item, click on Request another item to add further items.

Page 4

Help with using the referral form

Join the Stripey Stork mailing list

Stripey Stork - Family Support. Recycled

Site Links

Our Policies

Other Baby Banks

Page 2

Please provide information about the household and individual family members. Click on add another household member to add more.

Page 3

Please complete a request for each item, click on Request another item to add further items.