CHILKAT VALLEY SUPPORT CHAIN INITIATIVE
THANK YOU FOR YOUR HELP SUPPORTING THOSE WHO MAY NEED IT WHILE WE WEATHER THIS PROLONGED PERIOD OF PHYSICAL DISTANCING.
By signing up any individual or family, you are agreeing that you have received permission / consent to do so. Also, if you meet the criteria listed in the second Volunteer portion of this survey, please consider signing up to help meet our community's needs. We will do our best to make contact those in need as soon as possible. Thank you!
Name of person(s) / family who needs assistance
Home Phone / Cell Phone Number(s)
Your Name if filling form out for someone else
Your Phone Number if filling out form for someone else
Area of Residence
26 Mile / Mosquito Lake Area
30 Mile Haines Highway & Beyond
Middle (2-20) Mile Haines Highway
Physical Address (Please include any helpful descriptions of resident's location.)
Phone Call Check - In
Delivery of Pre-Paid Groceries
Medication Pick up / Delivery
Mail Pick Up / Delivery
Library Materials Pick-Up / Delivery
Family Food Box Delivery
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service