Covid Support Drop-Off Form

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Please choose a time for your estimated drop-off below and let us know what you plan to donate.

You will receive a confirmation email from Eric@EricsJourney.org in 24-48 hours after your submission has been processed by one of our volunteers.

Email *

First Name *

Last Name *

Street Address *

City *

State *

New Jersey

Zip Code *

Estimated Drop Off Date *

Please leave items under the carport on the right side. Note: We are not accepting visitors in our home at this time.

YYYY

Estimated Drop-Off Time *

Please choose all that apply.

Morning (After 7AM)

Midday

Afternoon

Evening before 8PM Curfew

Required

What types of item(s) are you donating? *

Surgical Masks

N95 Masks

Homemade Masks

Gowns - including surgical and isolation

Gloves

Goggles

Snacks (Individually packaged Only)

Drinks (Individually packaged Only)

Other:

Any other comments and/or questions?

Send me a copy of my responses.

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