JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Time Bank Community Supported Families~support vision for community participants
To participate as a service provider in this program, you must be a member of the time bank and you must have completed at least one exchange through the time bank before being matched with a family to begin supporting them. If you're not yet a time bank member, you can sign up at:
https://www.sebastopoltimebank.org/join
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is your name?
*
Your answer
What season would you like to participate?
February - March 2020
May - June 2020
August - September 2020
Clear selection
Can you share your address for the sake of trying to match you with folks nearby? This pilot program must be in the 95472 or 95444 area code.
Your answer
Best phone number to contact you at during the program.
Your answer
What do you hope to gain out of this experience?
Your answer
In this pilot you'll be providing an important service to a new family. What does being of service mean to you?
Your answer
What are some of your skills and gifts that might be particularly useful for new families?
Your answer
While we all have opinions about how to care for babies, this program seeks to provide a safe, judgement-free space for new parents. Are you willing to provide support to families without offering unsolicited advice?
Yes
No
Not sure
Clear selection
What are you willing to offer in support of the new families? (please check all that apply) ***Please note: out of respect for families' preferences, you will not be holding or directly caring for their baby unless your assigned family specifically requests it.
Picking up groceries
Running errands (post office, dropping things at bank, picking up to go food, etc)
Pet care (dog walking, dog/cat petting, poop scooping in yard)
Garden and yard tending (weeding, trimming back plants, watering)
Light home care (general tidy, wash dishes, toss in load of laundry, fold laundry, sweep, vacuum, wipe counters, make beds)
Meal preparations and delivery
Other:
What are your boundaries? Families receiving community support will respect boundaries and practice clear communication, request and receive consent.
Your answer
How much time are you willing to offer a new family?
1-2 hours two days a week for 6 weeks
1-2 hours one day a week for 6 weeks
Other:
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
