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UCC Helping Angels
Patriots here to help you during the Covid-19 epidemic. This form will serve to connect those who can volunteer their time to those who are in need of assistance.
Please Fill out the form below and we will contact you with the next steps.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
Address 2
Your answer
City
*
Your answer
Zip
*
Your answer
Cell Number
Your answer
Home Phone Number
Your answer
Email Address
*
Your answer
I am interested in
Receiving Services
Volunteering my time (Driving/Pick up/Shopping)
Other:
Other Assistance Needed
Your answer
Available Days & Hours
9 am - 11 am
11 am - 1 pm
1 pm - 3 pm
3 pm - 5 pm
5 pm - 7 pm
7 pm - 9 pm
variable
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9 am - 11 am
11 am - 1 pm
1 pm - 3 pm
3 pm - 5 pm
5 pm - 7 pm
7 pm - 9 pm
variable
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Additional Comments
Your answer
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