Community Assistance Support for Quarantining Families
Thank you for your interest in supporting Tri-Town families who are quarantining due to Covid concerns.  We are looking for community volunteers to help support families  by grocery shopping for them, picking up materials at child's school, picking up prescriptions and other local errands. Please fill out this form as completely as you can and someone from the TTC team will reach out to connect.  Thank you.
Sign in to Google to save your progress. Learn more
Name: *
Are you over the age of 21?  (Kindly indicate your age range below): *
Email: *
Phone number: *
Town in which you live: *
Preferred method of contact? *
3 non-family members who could serve as a reference for you - kindly include their name, relationship to you, and contact info. *
Do you have a valid driver's license? *
Do you have access to a car to use for errands/deliveries? *
What would be your preferred method of reimbursement? *
Required
Confidentiality Agreement:  Please type your  name below to indicate you understand the following statement.  I will keep all personal details about the family, their needs, diagnoses, and other personal information private and confidential.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Tri-Town Council.

Does this form look suspicious? Report

Google Forms