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HIWP Errand Request Form
The Kesharim Committee is set up to help with small errands and shopping for those who are self-isolating or quarantined at this time.
***Please note that the volunteers will not be able to aid in errands that do not comply with social distancing policies.***
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Cell Phone Number
*
Your answer
Address
*
Please include apt # if applicable
Your answer
Does your apartment building have a doorman or any other delivery specifications?
Your answer
What do you need?
*
Please clearly state what your errand need is and from where
Your answer
When you do you need this task completed by?
*
Please state a date and time if applicable. If there is no time limit, please specify.
Your answer
Please specify how you would like to handle reimbursement to the volunteer
*
Electronically: Zelle, Paypal, Venmo, etc.
Cash in envelope
Check in envelope
Is this a new request or an update to a prior request?
*
New
Update
Please write a detailed list of the items required below
*
Please include brand names and exact quantities for all items. If for prescription pick up, include exact medication name, dosage and recipient date of birth.
Your answer
Do you have any additional instructions for the volunteer? Be specific!
*
I.e. Please buy only organic produce
Your answer
A copy of your responses will be emailed to the address you provided.
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