Needs sign-up sheet during COVID-19 outbreak 新冠疫情期间需要帮助登记表

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In response to the COVID-19 outbreak in our local communities, Toledo Chinese Alliance Church (TCAC) have assembled a group of caring volunteers who are willing to provide help with some essential needs to the best we can, within the scope of official guidance and orders. If you need such services as listed below, please take a couple of minutes to fill up a quick questionnaire so that we know how to help you. Thank you and stay safe!

在此新冠病毒疫情在本地社区爆发传播之际，多丽都华人宣道会组织了一群有爱心关怀的志愿者，在政府的要求和规定范围内，愿意竭尽全力来为本地社区里有需要的民众提供必要的帮助和服务。如果您需要下面列举的帮助和服务，烦请您花2分钟时间很快地填写下面的登记表，这样我们就知道怎样来为您提供帮助。谢谢，保重！

Please make sure you click on "Submit" button (at the end of this page) and see a confirmation message "Your response has been recorded".

请您记得按 "Submit" 按钮（此页最下面）来提交，并且收到成功提交的确认信息 "Your response has been recorded".

Last Name 姓 *

First Name 名 *

Contact Number (digits only) 联系电话（仅限数字） *

Wechat ID 微信号 *

Your city 您所在城市 *

Please select your specific need(s) from the list below. 请您从下面选择您具体的需要。 *

Need non face-to-face conversation (phone, wechat, internet, etc.) for comforting, stress reduction and companionship 需要非面对面通过电话微信网络联系陪谈: 疏解焦虑,减少恐慌, 给予安慰

Need basic medical consultation assistance (not to cover diagnosis or treatment) 需要提供基本的医疗咨询帮助（不包括具体病患的诊断及治疗)

Need language translation assistance （English to Chinese， Chinese to English）需要语言帮助（英文翻中文，中文翻英文）

Need grocery/food shopping and delivery 需要购买生活用品/食物并送货上门

I have no needs right now. 我现在没有需要。

Required

If you want to have non face-to-face conversation, please select the most preferred way of communication (phone, wechat, internet, etc.) 如果您需要需要非面对面陪谈 , 请选择您最喜欢的交流方式（电话，微信，网络视频）。 *

Phone 电话

Wechat 微信

Zoom 视频会议

All the above, no preference 都可以，没有偏爱的方式；

I have no need to be contacted right now 现在我不需要联系。

If you need help with grocery/food shopping and delivery, please describe your current situation. 如果您需要购买生活用品/食物并送货上门，请说明你现在的处境。 This service will be preferentially provided to families who are quarantined, seniors who live alone or people with underlying health issues. 这项服务优先照顾被隔离的家庭，独居的长者和有基础病患的人。 *

I am or a family member is being quarantined 我自己或家人正在被隔离中；

I am a senior who lives alone 我是独居的长者

I have underlying health issues 我有基础病患

Other situation 其它情况

I have no need for grocery/food shopping & delivery right now 现在我不需要购买生活用品/食物并送货上门。

If you prefer calling us directly, please call the contacts below. 如果您想直接打电话，请联系下面的人。

Together we will pass through the storms, hand in hand, heart to heart and watching over one another in love. 让我们携起手来，互助互爱，共度难关！“如今常存的有信、有望、有爱这三样，其中最大的是爱。”

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