Personal Care Packs - We Care Connect

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1

PERSONAL CARE PACK REQUEST FORM

For families needing additional support please also complete our STANDARD REQUEST FORM.

Location and Opening hours:

We are located at:

Wyong - 43 Howarth Street, Wyong ( next to Vinnies), and open Monday to Friday) between 9am-2pm.

Thornton - 2/28 Glenwood Drive, Thornton, and open Tuesday to Thursday between 9am-2pm.

Agency Information

Please give as much information as possible so that we can best match items to the needs of the family.

Case Worker Name

Contact Number

Email

Agency - Program

Town/Suburblocation of program

Requested Collection DatePLEASE allow at least 5 working days between your request and collection dates unless Urgent

Please let us know as soon as possible if you are unable to collect your Request on your nominated day. Please email or text to 0432 079 213.

Client Details

Client IDName or ID

Does your client identify as Aboriginal or Torres Strait Islander?

YesNoNot known

What are the causes of disadvantage for this family?Select all that apply

Family ViolenceKinship/Foster/Emergency CareHomelessness/Risk ofMedical/Disability/Mental HealthSingle ParentUnemploymentYoung ParentOther

Items Request

Child 1

Child 1

BoyGirl

Child 1 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Please select 1

6-month pack3-month packtop-up items

Please select Girl

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Child 2

Child 2

BoyGirl

Child 2 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Child 2 Items

6-month pack3-month packtop-up items

Please select Girl

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washCombDeodorantFace washerFlossHair brushHair trimmerLip balmShampoo / ConditionerShaving kitToothbrushToothpaste

Child 3

Child 3

BoyGirl

Child 3 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Child 3 items

6-month pack3-month packtop-up items

Please select Girl

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washCombDeoderantFace washerFlossHair brushHair trimmerLip balmShampoo / ConditionerShaving kitToothbrushToothpaste

Spacer

Do you have additional children requests?

Yes

Child 4

Child 4

BoyGirl

Child 4 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Child 4 items

6-month pack3-month packtop-up items

Please select Girl

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washCombDeoderantFace washerFlossHair brushHair trimmerLip balmShampoo / ConditionerShaving kitToothbrushToothpaste

Child 5

Child 5

BoyGirl

Child 5 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Child 5 items

6-month pack3-month packtop-up items

Child 5 G

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washCombDeoderantFace washerFlossHair brushHair trimmerLip balmShampoo / ConditionerShaving kitToothbrushToothpaste

Child 6

Child 6

BoyGirl

Child 6 - Age

Any special Notes:Colour preference, hair type, complexion + any special needs/likes etc

0 /

Child 6 items

6-month pack3-month packtop-up items

Please select Girl

Body washComfort items - smallCosmeticsEmery boardsFace wipe packsHair brushKnee rugs - bright coloursLip balmMoisterizerNail polishOvernight briefsPurse packs (sanitary/undies)Roll on deodorantSanitary pad packsSanitizerShampoo / conditionerSoap packTampon packsTissue packs - smallToothbrushToothpaste

Please select Boy

Body washCombDeoderantFace washerFlossHair brushHair trimmerLip balmShampoo / ConditionerShaving kitToothbrushToothpaste

Additional Notes / Requests

0 /

Location and Opening hours:​

We are located at:​

Wyong - 43 Howarth Street, Wyong ( next to Vinnies), and open Monday to Friday) between 9am-2pm.

Thornton - 2/28 Glenwood Drive, Thornton, and open Tuesday to Thursday between 9am-2pm.

​

Location and Opening hours:

We are located at: