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Pandemic Solidarity Support Form 🌹
It's very important that our elders and other neighbors at risk of a life-threatening coronavirus infection avoid being out in public for the time being. We believe everyone deserves to live securely, so for those who would struggle to pay for deliveries of their basic needs, Chico Democratic Socialists of America is organizing volunteers to provide support.🌹
Please fill out this form so we can coordinate and keep track of our deliveries. We will always try and be as prompt as can be, but if the need is especially urgent, please indicate. We are entirely volunteer-run and do this out of pure solidarity ✊ i.e there is no cost for delivery. We only ask for reimbursement of the cost of the groceries on the receipt [via cash, card, or check].
We maintain a strict sanitation policy, using gloves and masks while we shop and deliver. Following that, these will be 'no contact' deliveries and we, unfortunately, cannot help carry groceries into the house.
An on-duty volunteer can be reached by call or text at 530 645 2028; or by email at email@example.com.🌹
Address (for Delivery)
Preferred Day of Delivery
Another Day / No Preference
Preferred Contact Method
Is this urgent?
How many people is the delivery for?
What do you need delivered?
Preferred Store / Pharmacy (Optional)
Please provide a list of what you need delivered.
Send me a copy of my responses.
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This form was created inside of Green DOT Transportation Solutions.