Roseville Volunteer Force Request for Help Form
This form should be used by seniors, people with medical conditions, single moms, or similar, that struggle with getting supplies or necessary errands that they need. If you are able-bodied and just can't find the supplies/services you are looking for, please post those requests in the Roseville Volunteer Force Facebook (https://www.facebook.com/groups/VolunteerForce) group to see if the group volunteers can assist you with those needs.

NOTE: The information you provide below will only be shared with our leadership and the volunteer(s) that help you obtain these items or services. It will not be used for any other purpose.
First & Last Name *
Are you a Senior? *
Do you have special medical condition that requires you to stay home? *
What is it that you need?
What specific items do you need that you can't find?
Pet Needs
Can you safely pick up goods from someone's porch or do you need it delivered to your porch?
Clear selection
Street Address and Apt # if Applicable *
Gate Code or Other Instructions? Otherwise Enter N/A *
Area of Town / Nearest Cross Roads/Intersection / Landmark *
City *
Home Phone *
Mobile Phone (N/A if not applicable) *
If Mobile phone, can we text you?
If you don't know how to text or don't have texting capability, please select No.
Clear selection
If reimbursement is necessary, what form can you use? *
If assigned a shopper, DO NOT offer a credit card to the shopper!
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy