Elders Registration Form v1
We are reaching out to elders above the age of 65 and living in Bhubaneswar and here’s how you can help us.

#CovidSupportForElders is an effort to minimise the need for you or your loved elder to step out and to help them overcome loneliness during this phase of social distancing and self-isolation.

#CovidSupportForElders-Bhubaneswar is not a service provider but a community based initiative linking elders with nearby registered volunteers operating under strict guidelines.
By filling up this form the recipient agrees to abide by the protocol set by the initiative.

This is a non- (physical) contact volunteering assistance and requires understanding of the limitations and an exercise in caution and restraint in dealing with the volunteer assigned.

We may link you up with other people close to you who want to help and build group chats around this. This data currently runs through google forms and through other google products. If you'd prefer to use email instead, write to us at covid19volunteering@gmail.com
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What kind of help would you find most useful?
Is this support needed right now?
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Name
Contact information (any two)
Phone Number
Email
WhatsApp
Facebook
Which area/ locality is the support needed – (this is a physical contactless program, but we will try to assign volunteers close-by for best-fit)
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