Childcare Needs Assessment

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WHO: We are medical students who are looking to help providers in the New Orleans area who need help managing their household while serving at the frontlines during COVID-19.   

WHAT: This form is intended for ALL healthcare in the New Orleans area looking for help with childcare/babysitting to make connections with current medical/health professions students looking for ways to help during this COVID-19 pandemic.   

WHERE: In or around the New Orleans area.

 WHY: We want to support you as best as we can during this important time of community effort! It takes a village! This project is NOT organized through the medical school and is solely made up of volunteers acting independently from any institution or organization. Please direct all questions to jlim2@tulane.edu or ccoren1@tulane.edu.  

HOW: After you fill this form, we will look at our central database which contains names of students who are able to help with the above-mentioned. We will connect you with at least 2 health professional students via email, after which you can make plans as your schedules work! Having a central document for both requests and connections will help us minimize confusion and cross talk.  Please note that this service is flexible and might change daily. We will do our best as students to support you! In return, we ask for your timely response to students and to be aware of our own limitations.  

PLEASE READ: If you or anyone in your household meets any of the following criteria, we are unable to partner with you at this time and we apologize: 
 - Experienced a fever in the past 2 weeks
 - Experienced shortness of breath in the past 2 weeks  
- Traveled to Europe, China, South Korea, Iran, California, New York, etc. in the past 2 weeks  
- Had contact with anyone diagnosed with COVID-19 
- Are not fully immunized (standard + current influenza immunization)

Email *

Name:

Phone number:

How do you want to be contacted?

Phone

Other:

How many children do you have?

Other:

Clear selection

What are the age(s)?

What times/days do you need help (understood that this may change or be unknown)?

Any special needs, requirements, requests?

What neighborhood do you live in?

If necessary, would you be okay having childcare at someone else's home?

Yes

Maybe

Other:

Clear selection

Do you have pets? If so what kind?

Are you able to offer any compensation to childcare volunteers?

Yes

Maybe

Other:

Clear selection

Any other comments / questions / concerns at this?

Statement of Understanding - Please agree to the following statement: *

Please follow official guidance and common sense precautions regarding exposure history, and refrain from participating if you or any household contacts are symptomatic. This is an offer to help, not enrollment in a program offered by or endorsed by any employers or academic institution. This program is not endorsed by the employers of its participants or any affiliate organizations. We are an informal movement comprised of private individuals who want to help connect frontline health workers with options for assistance in this crisis. We do not assume liability for volunteers or frontline workers, and participants must use their own discretion to evaluate risk.Check the box to agree before proceeding.

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