Rockingham Help & Helpers-Sign Up
This survey is to bring us all together to coordinate and organize a community response to COVID-19. We will all be affected, and we also want to make sure our most vulnerable neighbors are supported and safe. 

TYPES of NEEDS: Folks may need help with food or prescription and that’s where this survey comes in. We want to build a team of volunteers that can support community members as the need arises. We will not use or share the info you provide for any other purpose than COVID-19 organizing in our local community. 

VOLUNTEER: This survey will help us to know who and how you are able to help. By checking "yes" you agree your info will be added to our list of helpers, and we will help connect you with opportunities to help. We know things right now are changing daily, so if you are no longer able to volunteer please do let us know.

NEED HELP: We will do our best to find a neighbor who will be able to help. Don't be shy to list your needs (now and anticipated). Anytime your needs and resources change, you can come back and fill out the survey again with updates.

SURVEY BY PHONE: Folks can take the survey by phone (802) 463-4270 let us know what you might need help with or how you can help.

SPREAD the WORD: Share on social media, reach out to your friends and neighbors, let them know we need their help and know if they need help.

SAFETY: Our medical community is asking us to stay at home and keep social distance of 6 feet. If you do go out, maintain distance, avoid going into anyone's home, and wash your hands before and after. We'll be asking any volunteers to follow Vermont Public Safety instructions to keep everyone safe and healthy.
https://vem.vermont.gov/neighborly

Thank you so much for your willingness to participate in caring for our community!

Rockingham Help & Helpers is a group made up of residents and organizations (Greater Falls Connections, Rockingham Free Public Library, Sustainable Rockingham, Rotary, Greater Rockingham Area Services, Fact TV, with the support of Rockingham Emergency Management and the Town of Rockingham
First Name *
Your answer
Last Name *
Your answer
Email Address
Your answer
How would you like to be contacted? Phone? Cell? via Facebook ?
Your answer
Where do you live? If you live somewhere else, consider starting a group in your community.
What is your 911 address?
Your answer
I or someone in my household is "High Risk" for Covid-19.
Do you need help or resources now or will you in the future?
Are you having trouble meeting your basic needs?
Do you have time and resources to give to our community?
How are you able to help?
Are you willing to reach out to others who aren't able to fill-out this form online?
Do you have any skills or resources you would like us to know about that might be helpful?
Your answer
Do you have other thoughts or ideas that you think would be helpful for us to know?
Your answer
By clicking here I give permission to share relevant information with people and organizations whom I can help or may be able to help me.
Are you considered an "Essential Employee?"
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy