JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 "I CAN HELP" FORM
Thank you for being willing to help your neighbors and community during this time. Fill out the form below, and we will be in contact with you when needs arise!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your name? (First and Last!)
*
Your answer
What is your phone number?
*
Your answer
What is your email?
*
Your answer
You can best contact me by...
*
Phone call
Text
Email
No preference
Required
How can you help? (if you have an idea that isn't on this list, please let us know!)
*
I'm willing to run errands/get groceries for people
I can provide some level of financial assistance
I just want to help!
Other:
Required
When are you available to help?
Please try to select times when you know you are ( almost always ) to ( always ) available to help with physical needs.
MON
TUE
WED
THU
FRI
SAT
SUN
Morning
Afternoon
Evening
Night
MON
TUE
WED
THU
FRI
SAT
SUN
Morning
Afternoon
Evening
Night
Is there anything else you want to tell us?
*
Your answer
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
