Request edit access
Kansas City Community Care and Mutual Aid Signup.
Times that are potentially scary require us to better support one another. In the same way that we bring casseroles to grieving families and baby clothes to celebrate newborns, we can come together as a community to help each other through this difficult time. An essential part of stopping the spread of coronavirus from overwhelming our hospital systems is voluntary self-isolation (https://www.vox.com/2020/3/10/21171481/coronavirus-us-cases-quarantine-cancellation). However, isolation can be difficult without the support of your neighbors. This form will help us provide support to each other!

Please give us as much contact info as you like, then tell us about potential situations where you might need assistance, so we can start to match up potential needs with potential offers. Then please make a check next to all potential supports that you have the capacity to provide. All offers of support will be kept confidential until a need arises. These are non-binding, but more to get a sense of the abundant resources we do have.

The CDC recognizes community preparedness as an essential part of dealing with this outbreak: https://www.cdc.gov/coronavirus/2019-ncov/community/home/get-your-household-ready-for-COVID-19.html

Thank you!
Sign in to Google to save your progress. Learn more
First Name *
Last Name
Pronouns (they/theirs, she/her, he/his, etc)
Neighborhood (optional but helpful)
Address (optional but helpful)
Preferred Contact Method(s) *
Required
Email address
Other contact method
As we connect with other groups, we will start sharing anonymous information about the kinds of needs our members have and the supports they can offer. May we also share your contact information?
What time of day are you more generally available? (Please check all that apply) *
What time of day are you more generally available? (Please check all that apply)
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy