YES - I'D LIKE SOME HELP

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Complete this form to let us know how we can help you...

YOUR CONTACT DETAILS

First Name *

Last Name *

Mobile number *

Email address *

Address: Street number and Street Name *

Address: Suburb *

I am currently self-isolating *

Yes

HOW CAN WE HELP YOU?

At the moment we can offer help in the following ways:

Phone calls / texts:
We can call or text you to check on how you're doing or call you on a regular basis if you're feeling alone or isolated.

Driving/deliveries/errands:
For those who are vulnerable or over 70 years of age and living in the Hutt Valley, we can shop and deliver your groceries for you.

Prayer:
Let us know below how we can pray for you.

Phone Calls / Texts *

Yes

Driving/Deliveries/Errands *

Yes

Prayer *

Yes

If you would like prayer, please let us know how can we pray for you...

Anything else you'd like us to know...

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