Community Senior C-19 Helpline Sign-Up Form
Fill out the following form and a volunteer will reach out to you shorty.
Reminder: Volunteers will NEVER ask senior citizen (65+) community denizens for their: PERSONAL MEDICAL INFORMATION, SOCIAL SECURITY INFORMATION, INSURANCE INFORMATION OR BANK ACCOUNT INFORMATION. VOLUNTEERS WILL NEVER ASK OR EXPECT TO BE COMPENSATED IN ANY WAY. This is a grassroots, FREE community initiative to help our most vulnerable community members secure vaccination appointments.