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Collection Request Form
Please fill in this form to request a collection of items for distribution by the Harrogate Scrubbers
The admins of the Harrogate Scrubbers group will hold your information for the purpose of allocating, delivering and receiving scrubs for the Harrogate Healthcare Community only. We may share information with volunteers for this purpose, but data will not be stored or used for any other reason. We will delete your data at the end of the project
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* Indicates required question
Name
*
Your answer
Email
Your answer
Address
*
Your answer
Postcode
*
Your answer
Landline phone number
Your answer
Mobile phone number
Your answer
Which is your Hub?
*
Furnish & Fettle - Northish of Harrogate (inc. Knaresborough, Boroughbridge, Ripon, Hamspthwaite, Killinghall etc)
Great Ouseburn - South Eastish of Harrogate (inc. Wetherby and Boroughbridge and the villages inbetween)
Main - Harrogate and Westish of Harrogate (inc. All Harrogate, Beckwithshaw, Harewood, Leeds, Otley)
I don't know!
What do you need collecting?
*
Scrubs
Scrub Bags
Headbands
Caps
Face coverings
Other:
Required
Are you a member of the Harrogate Scrubbers Facebook group?
Yes
No
Clear selection
Any comments for the person collecting your items? (eg. location, timings, etc)
Your answer
If you are asking for scrubs collection, please answer the following:
Were the scrubs made using a Harrogate Scrubbers bundle?
Yes
No
Clear selection
What size are they?
S
M
L
XL
XXL
Clear selection
How many complete sets are there?
Your answer
Any additional comments?
Your answer
Thank you. You’re a true community hero! Why not take a photo and tag us in on Facebook, Twitter or Instagram or email us on
harrogatescrubbers@gmail.com
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