Retired and Senior Volunteer Program (RSVP) of Highlands County-cotton mask request form

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Florida health care organizations/workers and seniors with chronic diseases within Highlands County, Fla. may submit a request.
The CDC considers this type of mask a "crisis mask" - non-medical grade. Cotton masks may be worn with a filter or over a medical grade mask.

Name of organization/individual *

Full name *

Contact phone number with area code *

Contact email address

Address of organization or individual *

What age category describes you? *

16-30 years of age

31-54 years of age

55-64 years of age

65-79 years of age

80 years of age or better

Reason for request *

Healthcare, law enforcement worker

Chronic health condition

How many masks are you requesting ( Individuals may request 2) *

What type of mask are you requesting?

Adult cotton fabric mask - three pleats with opening for filter with elastic over ears

Adult cotton fabric mask - three pleats with opening for filter with cotton fabric ties

Option 3

Other:

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Masks are machine sewn by RSVP volunteers. If you wish to donate 100% cotton fabric, elastic ( 1/8 inch, 1/4 inch. round corded elastic, new elastic hair ties), twist ties or Coats and Clark thread, Please contact: Kris Juve, coordinator, RSVP at: rsvpvolunteersforhighlands@gmail.com

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