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     CARA: Irish Communities Together through COVID-19      Support Request
Irish Community Groups across the North West are working in partnership to support our communities during the period of Covid-19. We are coordinating this partnership through Irish Community Care, and we have an amazing group of community volunteers supporting the CARA Programme.

If you or someone you know cannot leave home because of the coronavirus threat and need help because there is no-one locally who can give you support, please let us know and we will work together to get you this support.

The information you share with us will be stored and processed in accordance with current GDPR guidelines.

By completing this form you are confirming that you are happy for us to share relevant details with the volunteer who will be supporting you. Please complete this form with as much detail as possible. Or you can give us a ring on 01512373987 and we will complete the form with you.
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Details of person requiring support - Full Name *
Date of Birth *
Full Address *
Please include house number, street name, City/Region & Post Code
Telephone Number *
Email Address (If available) *
Ethnicity/Cultural Background *
Are you requesting support for someone else? *
If Yes please provide your contact details below
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