Laurelhurst Neighbor 2 Neighbor Contact Form
LN2N is a Laurelhurst neighbors mutual support group for Covid-19. We want to connect neighbors who can help - e.g. with grocery shopping - other neighbors who need to shelter at home because they are at high risk from the virus. All answers strictly private, only for use by LN2N and Laurelhurst Neighborhood Association (LNA). Please complete and click send. Contact LN2N.lead@gmail.com with questions. Or call John Liu, 510-847-0070.
Your Name. (Optional: your significant other's name too.) *
Your answer
Your Street Address *
Your answer
How Many Adults Live In Household
Anyone In Household Over 60 Years of Age? *
Do You Need To Shelter At Home During Covid-19? (Due to age, medical conditions, doctor's advice, or other reasons.) *
Will You Need Help From Neighbors With Shopping / Other While Sheltering At Home? (Due to no-one in household or nearby available to help you.) *
If You Will Need Help, Please Explain: What Help?
Your answer
How Many Children Under 10 In Household?
Any Medical Professional (MD, ND, RN, DO, etc) In Household? (Optional, if willing then details please)
Your answer
Any Emergency Services / First Responder in Household? (Optional, if willing then details please)
Your answer
Does At Least One Person In Household Drive And Have Consistent Access To A Car?
Do You Know A Neighbor Who May NEED HELP From Neighbors To Avoid Exposure To Virus?
If Yes, Please Tell Them About LN2N And Ask Them To Fill Out This Contact Form. (If they cannot access the form, please do it for them or tell us their name, address, and phone - IF they agree.)
Your answer
Are You Willing To Help A Older / Medically Fragile Neighbor With Shopping? (Not forever - just temporarily.)
Are You Interested In Being A Block Rep For LN2N? (Block reps will help match up neighbors who need help with nearby neighbors who want to help, so that no-one gets overlooked. Saying "yes" means you'd like to hear more about this: you're not committing.)
Are You Interested In Being A Quad Rep For LN2N? (Quad reps will help coordinate block reps. Saying "yes" means you'd like to hear more about this: you're not committing.)
Your Email. (Optional, but lets us contact you)
Your answer
Your Phone. (Optional, but lets us contact you)
Your answer
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