Heart for Hounslow - Community Support: I Need Help
Hello!

If you are self isolating, or are placed in a vulnerable position in someway due to the covid-19 crisis, would like to see what we can do to help as a church. Please fill in the form below and someone from the team will be in touch.

---
Privacy Notice
The information collected in this form will be used for legitimate purposes - to help connect communities during covid-19. It will be shared amongst the clergy and pastoral team of HT Hounslow to enable our Heart for Hounslow campaign to help the most vulnerable in our community during this crisis.

 - Please do not upload information on behalf of others.

 - Please be aware that any sensitive information that you may give on this form will be held in the strictest of confidence, but may be shared between clergy, pastoral team and/or volunteers assigned to help, in order to assist more fully.

To remove your data or ask any questions, please contact us at: info@hthounslow.org.uk. To view our privacy policy in full go to: https://hthounslow.org.uk/privacy-policy
Sign in to Google to save your progress. Learn more
Full Name *
What is your address
Please only share this information if you are comfortable to do so, and would like for us to connect you with people nearby who might be able to call, or if we need to bring items to your doorstep.
Phone number *
NB: we may need to contact you via whatsapp or text, so a mobile number is useful, however not essential.
Have you ever shown symptoms of or have you ever been diagnosed with COVID 19 in the last 30 days? Please answer honestly to enable us to prioritise everyone's Health and Safety. *
What practical help do you need *
Required
Prayer Support
We acknowledge that prayer is not everyone's cup of tea, however please do mention here is you are happy for us to pray for you and whether a trusted volunteer may be able to do that for you whilst maintaining social distancing best practice.
Clear selection
Coronavirus is contagious. Please take every precaution to ensure you are spreading only kindness. Avoid physical contact (2m distance), wash your hands regularly and if delivering items, please leave them on the doorstep. Tick below to confirm you understand. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of HT Hounslow. Report Abuse
Google Forms