Request Form for PPE
Frontline or Essential worker - we require your work email for verification. If you are not able to provide your work email, please provide your personal email and send an email with a photo of your organization/work identification to:  protectfrontlineworkers@gmail.com.

For low income and/or immunocompromised individuals,  please provide your email so that we may reach out to you should we require more information.

*Be sure to check your Junk/Spam folder for emails from us.
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Full Name *
Which group/organization is this request for? *
If you are not part of a group or organization, add a brief description about you
Select the option that best fits your situation: *
What are your immediate needs? *
Due to high demand, we can't promise to provide everything.
How many cloth masks?
What size? (Child, Small, Standard, Large)
We will try to do our best to fill the size requests, but this will be taken as a guideline and may not be fulfill completely
How many ear savers?
How many caps?
How many laundry bags?
Reserved for people that work with COVID positive patients and in vulnerable communities.
How many isolation gowns?
Reserved for people that work with COVID positive patients and in vulnerable communities. If you are able to purchase gowns you can do so here: https://www.bcapparelandgear.com/covid19
Can you pick up when the PPE is ready? *
Phone Number *
Required should we need to further contact you.
Could you or the organization donate to our GoFund Me to cover materials? *
Is there a preferred material for the PPE you are requesting?
PPE specific needs or color requirements is something we can arrange under a cost to cover for materials. If you don't have specific needs, we will provide what's available at the moment
General comments
*Drop off information
Hospitals are not an option for a drop zone at the moment. We are not currently mailing items.
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