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Nominate a Loved One 🤎

NOTE: The next delivery date available is in November🫶
Nominate yourself or a loved one to receive community support.
Firstly, a big thank you for wanting to support someone you love! Before you start filling out this form, please read the below notes:
🤎 We only service Warrnambool and it's surrounds (up to 30mins from Warrrnambool). If the person receiving is outside of this service area, we can still work something out (e.g. you or someone you know makes the delivery, or we can meet halfway etc.)
🤎 Also note that there is a minimum contribution fee of $50 to make this service possible.
If you have any questions, please don't hesitate to get in touch with me via socials or email.
The below questions are about you, the nominator, so I can get in touch with you about this nomination.

Email

Name

Instagram Handle

If you don't have Instagram, type N/A
The below questions are about the person receiving the support.
Please give as much details as you can so we can best support the family receiving.

Name of person recieving

When is the Delivery for? (subject to availability)

Your proposed date or an alternative date will be confirmed via email within 48 hours.

Their address

Including any info needed for delivery e.g. hidden driveway, gate code, beware of dogs, best place to leave the care package etc.

Any dietary needs in the household?

Any allergies in the household?

Are they breastfeeding?

A
B
C

How many people in the household?

Any older children? If yes, please share age and gender

Is there anything else to note?

Below is the link to complete the cash contribution fee for your nomination

Please select "🤍 Nomination Contribution Fee" from the dropdown box (Choose how your donation supports The Village).
OR you can make your contribution via bank transfer:
Account Name: M J Heap
BSB: 633000
Acc No: 227083458
Reference: Your Name + Village