Baltimore Hosts Sign Up Here

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Join us in making an impact for Baltimore Singles!

Please complete this form to sign up to host singles for Shabbos & Yom Tov meals.

We appreciate if you would share this form so we can ensure that all singles in the Baltimore Community will have a place if needed.

Thank you,

Shoshi Glazer
Rochel Ziman

Questions - contact@asingleimpact.com

Donations - asingleimpact.com/donate

First Name(s) *

Last Name *

Cell Phone Number *

Email Address *

Best way to reach you: *

Call

Text

Required

Home Address *

Neighborhood you live in *

Shul you attend *

Shul(s) near you *

Guest COVID Preferences *

Guest has antibodies

Guest is fully vaccinated

Guest wear masks while in your home and can remove while eating

No restrictions

Other:

Required

Host COVID Information *

Can maintain social distancing comfortably

Family has antibodies

Family is fully vaccinated

Hosting guests regularly without restrictions

Other:

Required

Food Preferences (ie. vegan, vegetarian, etc.)

Short bio of your family and home style *

How did you hear about us? How did you hear about this initiative? *

Anything else you want to share?

Submit

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