Pay It Forward Mental Health Packs - Applications

WE ARE NOT TAKING ANYMORE APPLICATIONS

This is an application/nomination questionnaire to be filled out by individuals who want a FREE Mental Health Pack, or those who are nominating someone they know needs a pick me up. We are also able to offer multiple packs to organisations, businesses and service providers. Please answer ALL relevant questions.

Donations are provided by our community and customers and are given by the kindness of strangers. We will also be donating a percentage to this cause as well.

Please note that filling this out does NOT mean you will be eligible for one, we will do our best to give everyone a pack but we may not be able to achieve this if we do not get enough donations.

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* 1. Full Name (Legal Name)

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* 2. Preferred Name

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* 3. Address (to ship pack to)

Address

Address 2

City/Town

State/Province

Postal Code

Email Address

Phone Number

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* 4. Organisation or Service Providers Details (if applying as a business or company)

Business Name

Postal Address

Suburb, State and Post Code

Contact Phone

Contact Email

Contact Name

Number of Packs you require

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* 5. Why do you want/need a Mental Health Pack paid forward?

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* 6. Please note any triggers, allergies and preferences here

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* 7. How did you hear about our Free Mental Health Packs?

Instagram

TikTok

Facebook

Emails

Other Small Business (share with us!)

Community or Mental Health services

Other

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* 8. Please tick the below

I have read what Tools are in the FREE Mental Health Essential Kits.

I understand that by filling this survey I am not guaranteed a Kit, but know For Your Mind Boxes will try their best to send me one.

I have listed any allergies above.

I understand I cannot make changes to my kit unless there are allergies or triggers.

I have answered all relevant questions.

I am over 18 or have permission from my parents to receive this package.