Little Downham & Pymoor COVID 19 Request for Support

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Please use this form to ask for help during the COVID 19 pandemic. We will only share your information with a matched volunteer.

Untitled Title

What is your name? *

How would you like us to contact you? Please give us a telephone number or email address. *

Which of these best describes your current situation?

I am self isolating with symptoms of Coronavirus

I am self isolating because I have received a letter from the NHS telling me to stay at home

I am self isolating because I am over 70 or care for someone who is

I am self isolating because I have other vulnerabilities or care for someone who does

I am contacting you on behalf of someone else who is self isolating

What support do you need?

I need help with shopping or delivery of supplies

I would like to have someone to ring and check on me or to chat with

I would like someone to keep in touch with me online

I need help with getting medications

I need help getting to medical appointments

I need help with childcare

I need help walking my dog or with pet care

Other:

Which of these places do you live nearest? (See image for street names in each area)

Area 1: Ely Road, Little Downham

Area 2: Lawn Lane, Little Downham

Area 3: The Droves, Little Downham

Area 4: Cannon Street, Little Downham

Area 5: Main Street, Little Downham

Area 6: Adventurers Drove, Pymoor

Area 7: Main Street, Pymoor

Area 8: Straight Furlong, Pymoor

Area 9: Pymoor Lane, Pymoor

Other:

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Please write a password for us to use when we contact you so you know we are genuine. Just choose a word and we will use it when we get in touch.

By clicking submit you agree for your data to be stored by District Councillor Anna Bailey for Little Downham & Pymoor COVID 19 Mutual Aid purposes only. You can withdraw consent at any time by emailing annabailey@hotmail.co.uk. *

I am happy for you to share my information with Little Downham & Pymoor Mutual Aid volunteers who might help

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