Senator Brad Hoylman's COVID-19 Volunteer Form

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Public health officials recommend "social distancing" to slow the spread of COVID-19. That means for some at-risk populations, it's better to stay home and avoid large groups at places like grocery stores and bodegas.

To help the neighbors who need it most, Senator Brad Hoylman is collecting a list of volunteers who are willing to go to grocery stores and pick up much-needed supplies and deliver to senior citizens and immunocompromised people in their communities.

The information you provide in this form will exclusively be shared with local non-profit organizations looking for volunteers. It will NOT be shared with any other elected officials or businesses.

Are you willing to volunteer and help your at-risk neighbors with errands and groceries? *

Yes, I volunteer to help

Do you have a car you are willing to use for pick-up and delivery? *

Yes, I have a car.

No, I do not have a car.

What is your First & Last name? *

What is your email address? *

What is your ZIP code? *

What is your phone number? *

Is there anything else you would like to tell us?

Submit

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