DC Ward 5 Community Care and Mutual Aid Signup
Scary times like these call for us to come together as a community and take care of one another! In order to slow down the spread of COVID-19 (coronavirus) and do our part to prevent our hospital systems from being overwhelmed, we need to practice as much social distancing as possible. Filling out this form will help us provide support to each other and the needs that we each have while also doing our part to minimize the risk of spreading the virus.

At any time, if you need some support (whether or not you have coronavirus), please email WARD5.MUTUALAID@GMAIL.COM and describe the situation and need. To the best of our ability, we will happily (and quickly) organize support for your home. All requests for support will be kept confidential except to those providing support.

For those who are volunteering their services, please take a moment to check out this document for guidelines and tips for safety: https://bit.ly/2TRnhr1

Thank you!

(Huge thanks to Jim Huang from Silver Spring and Takoma DC for the template of this form.)
Email address *
Name *
Your answer
Pronouns *
Pronouns are how we refer to you when we aren't using your name and being talked about (ex: like [she/he/they] wrote me a letter). Some examples of pronouns are (he/him, she/her, they/them).
Your answer
This is optional but would be helpful when making drop-offs or providing other support
Your answer
Phone number *
Your answer
What kind of phone number is this?
If the number above is a shared number/device with another person please let us know any instructions for contacting you (or how we should ask for you) in the box marked "other"
Add me to the WhatsApp Group for Ward 5 volunteers: (This is where we share requests) *
What time of day are you generally available? (Please check all that apply.)
How should we contact you?
How can we support you?
Your answer
I can provide the following kinds of support (check all that apply):
Are there any other supports not listed that you'd like information on how to find?
Your answer
If you marked the "running errands" option above, please specify if you have a car or other means of transport to do larger grocery runs, etc., or if you can only do smaller errands (picking up a small number of grocery items, going to the pharmacy, etc.)
Your answer
If you marked any meal prep options above, please list any particular cuisines that you are used to cooking (e.g. Somalian, Italian, Vegan)?
Your answer
Are there any types of specialized meals for which your kitchen is particularly well suited (e.g. if your household doesn't use nuts, it would be a good pairing for a neighbor who has a nut allergy)?
Are there any supports that you've offered above for which you normally charge as part of your livelihood? (ex: Providing childcare, house cleaning services, etc) Please list each one and your typical rate (while we want to offer these supports to each other for free, we also recognize the potential burden if this is a part of your livelihood, and we would like to make a plan to compensate you).
Your answer
Are there any currently available resources for residents of Ward 5 that you'd like to share?
Your answer
Are there other communities that you're connected to that would benefit from organizing some mutual assistance?
Your answer
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