Referral Form - Covid 19 Community Care
You can fill in this form yourself or complete on behalf of someone else with their permission.

- A member of staff from Rumi's Cave or Sisters for Allah will be in contact with you and arrange a volunteer to meet your requirements
- All transactions or befriending is undertaken in goodwill between yourself and the volunteer
- As circumstances are unpredictable, not all items requested can be provided
- If there are any issues please contact Glaiza (glaiza@rumis.org) or Khalida (sistersforallahgroup@gmail.com)
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Self-Referral
Please complete the form below, if completing on behalf of someone, you can add your details at the end.
Full Name
Age
Address with postcode
Mobile Number
Landline
Email
Other form of contact (i.e. social media)
Which language do you speak/prefer to communicate in?
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