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Cherry Burton COVID-19 Support Group Request for Assistance Form
Form to be filled in if you are requesting some community support or assistance.
The Parish Council Privacy Policy can be found here:-
http://www.cherryburtonparishcouncil.org.uk/Data/Sites/77/media/policies-and-procedures/dataprotection/cherry-burton-privacy-notice-final.pdf
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* Indicates required question
Email
*
Your email
Name (what you want to be called?)
*
Your answer
Address
*
Your answer
Phone Number (Home/Mobile)
*
Your answer
What assistance would you like?
*
Someone to help with shopping (food, medicine)?
Meal delivery?
Dog Walking?
Health Advice/Support?
Emotional Support (phone)?
Emotional Support (face to face at your door - subject to Coronavirus restrictions)?
Other?
Required
Are there any specific days/times when you require help?
Your answer
Anything else you wish to share?
Your answer
By clicking submit you agree for your data to be stored by Cherry Burton Parish Council for Cherry Burton COVID-19 volunteer aid group purposes only. Please select your consent to data sharing. You can withdraw consent at any time by emailing
cbpc@pjw.karoo.co.uk
I agree with the Privacy policy
Share my data with other local volunteers
A copy of your responses will be emailed to the address you provided.
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