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Colindale Mutual Aid
This form is for anyone wishing to join up with others engaging in mutual aid across Colindale.
Mutual aid is for everyone. Helping is inclusive and based on trust. #NeighbourtoNeighbour
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Full Name *
Email *
Address *
Postcode *
Which housing area do you live in? *
Contact Number - Mobile *
Contact Number - Landline (optional)
Which of these do you use? *
Required
Are you a high risk person? (e.g. elderly, immune compromised, diabetic, lung or heart or cancer patient)? *
How would you like join in and help neighbours? *
Required
How would you like to be involved? *
Required
If you need help, describe what you need?
Do you have access to your own car? Or Bike? *
Have you recently come into direct contact with any known Covid-19 positive patients? *
Are you thriving or surviving at the moment? *
Do you have a Blue Badge for a disability? *
Do you have any convictions, cautions, reprimands or final warnings as defined by the Rehabilitation of Offenders Act 1974? *
What's your super hero skill for helping others? *
When are you available
I am a... *
Please let us know if you are a carer? *
Are you first aid qualified? We are looking to identify anyone qualified in First Aid in case non-emergency assistance is required to reduce demand on the NHS *
Please list the languages you can speak
Can you use BSL sign language?
Clear selection
Any additional information you wish to share with us?
Data Privacy
By completing this form you consent to being contacted by Colindale Mutual Aid or sister Mutual Aid groups in Brent, Kingsbury, Hendon and Burnt Oak within the UK to support you and your family as part of the response to COVID-19.
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