Request Help Form
This is a form to request help if you need help with errands because you are trying to stay safe at home because you are at high risk for COVID-19 (over age 60 or other health concerns) or you are sick and trying keep others healthy.

Please answer a few questions to tell us what you need and we will help match you up with a volunteer. The volunteer will contact you by phone to arrange to deliver your items.

This initiative is being run by private citizens to help our neighbors and community. We do not have the funds or the capacity to run background checks or screen participants beyond, at most, a friendly phone call. We are trusting that the people of Portland will continue to be good, honest and kind to one another.

**By completing the sign up form to be matched you agree that you accept all risk and responsibility and further hold any facilitator associated with this informal service harmless. Neither the facilitators, requestors, or helpers are responsible for any liability--whether health or financial--that may result.

If you have questions or need to report a problem, please email NEPcovidresponse@gmail.com
What is your name? Please use real first and last names. *
Your answer
What is your phone number? *
Your answer
What is your address (or a nearby intersection)? *
Your answer
What items do you need? *
Your answer
How urgent is your need? *
Estimated cost *
Your answer
Payment method *
Other comments, or anything else we should know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of www.marisamorby.com. Report Abuse