Referral Form
‘Toys on the Table’ is a Charity working in the Leicester and Leicestershire* area, which aims to provide toys or gifts at Christmas for those children who might otherwise not receive anything.
*Some areas are covered by other agencies. If we receive a referral sheet pertaining to a separate agency, we will forward it directly to them.
Is this a self-referral? ...... If not, please give details of person or organisation referring or recommending this family:
Contact Details of person or organisation making referral:
Name: ...... Organisation/Team (if applicable) ......
Contact Point: Address: ......
Tel: ...... Mobile: ...... Email: ......
Connection with family: ......
* * * * * * * * * * * * * * * * * * * * *
Family Referred: Surname: ......
Parents’ Forename(s): ......
Address: ......
Postal Code: ...... Telephone: ......
Name of Child / Age / Boy / Girl / Special NeedsNo of children (up to 16 yrs): . . . . . Does the family have a CD/DVD Player? Y/N
For additional children, please continue on the back of this form. See over è
All information collected will be stored on Toys on the Table database
Please return this form to: Toys on the Table, 41 Edgeley Rd, Countesthorpe, Leicester LE85QN For enquiries please telephone: 0116 2784001 (Terry Watts) or 07939-430525 (Bill Bowley) Email:
Website: www.toysonthetable.org.uk
PLEASE DO NOT USE THE PO BOX NUMBER AS THIS HAS BEEN DISCONTINUED
Please return ASAP, but in any case no later than 16th December 2016
Name of Child / Age / Boy / Girl / Special Needs* * * * *
Notes for Completion of Form
1. Toys, or gifts for the older ones, will be prepared on the basis of the information submitted on this form. Thus, if there is extra information that would be useful in this exercise, such as a child’s known particular interest, please use the “Special Needs” section to make us aware. We are, of course, unable to guarantee supply of toys or gifts according to such preference as this will, as always, depend on availability, but every effort will be made.
2. Toys should be collected from our wrapping / distribution point preferably in the week commencing 12th December, although earlier collection can be arranged. With very limited exception we are unable to deliver toys. These should in general always be delivered by the referrer.
3. Please ensure that the contact telephone number of the referrer is included in the appropriate place above, together with the alternative. We will then try to ensure that you are informed when the toys are available for collection.
4. Please return this form to: Toys on the Table, 41 Edgeley Rd, Countesthorpe, Leicester LE85QN
by Fax to: 0116-2783923
by email to:
PLEASE DO NOT USE THE PO BOX NUMBER AS THIS HAS BEEN DISCONTINUED
5 For more information contact 07939-430525 (Bill Bowley) or 0116-2784001 (Terry Watts)