If you are completing this form for someone else, please note that here, as well as their contact information.

Please note this is not a secure form, so we strongly urge you to not share private or medical information you would not share on Facebook.

By selecting "I agree" below, I agree that I would like to be contacted by this CAN (Commnity Action Network) to receive information or a match and/or be contacted by my match directly. By completing the sign up form to be matched to receive or provide voluntary services, you agree that you accept all risk and responsibility including any injury or harm that may result from providing or receiving services, and further indemnify and hold any facilitator or volunteer associated with this Community Action Network harmless. We are not healthcare professionals, if you need medical advice, please call your doctor or South African Department of Health emergency services directly.