Please only use the secure form below if you are a professional working with children. Items can be delivered to the family, or you are welcome to collect them from our offices in Wokingham.


Please submit one form per family. If there are multiple children within the family requiring support then please complete the ‘Items Required per Child’ section for each child.  You do this by clicking the ‘Add Another Child’ link towards the bottom of the form.

You will receive an email confirmation once your form has been successfully submitted. This will include a unique reference number for your referral. Please respond to this email if you have any questions or need to update your referral.


If you experience any problems completing or submitting this form, please email or call 07733 062597 for assistance. 


If you receive an error message when trying to submit the form yet receive a confirmation email, please be assured that we have received your referral.  If you do not receive a confirmation email then please contact us.