COVID-19 "Request Support" Form
CityLight Vineyard Church in Newark DE (and possibly other local churches we have relationship with - we will update as we go) is seeking to provide assistance to those affected by the coronavirus pandemic in Newark, Elkton, and Avon Grove—especially those impacted by social distancing, self-quarantine, illness, and loss of work.

Please use this form if:
- You need someone to run an errand for you, shop for groceries, or pick up your prescriptions.
- You are feeling lonely, depressed, or anxious during social distancing and self-imposed quarantine, and would like to receive a caring phone call or Zoom call for conversation and/or prayer.
- You need food but currently don't have the financial means to purchase enough.

We will try to fulfill all needs as expressed. If this becomes unsustainable for our volunteers we will prioritize support for those most in need. (Also - we will continue to work to fulfill needs as long as we are allowed to by the restrictions set forth by local and national government.)
Helpful Information
First please provide us with some helpful information so we can do our best to fulfill your request. Further down the page you'll be able to select what support you are requesting.
Name
Your answer
How should we contact you?
Please include your phone number, email, and/or Facebook Messenger--give several options if possible.
Your answer
Delivery Address
Your answer
What time and day do you need things by?
Please allow us 48 hours to respond to your request. We can't guarantee delivery times, but we can do our best.
MM
/
DD
/
YYYY
Time
:
Any additional specifications, comments, questions, accessibility needs, or drop off instructions?
Your answer
What kind of support are you requesting?
Do you need someone to run an errand or pick up a prescription for you?
If so please describe the errand below, and we will contact you for more specifics. Since Google forms aren't secure, we will reach out to you through your contact info to get prescription details.
Your answer
Do you need someone to grocery shop for you?
If so please provide us with a grocery list. Items can be general like "milk," or specific like "a gallon of 2% milk." We will do our best to match your requests, but if we can't find something specific we may get you a similar substitute. We trust you to know your needs and we are committed to delivering without judgement.
Your answer
Would you like to receive a "care call?"
If yes, when is best? There is a small collection of caring volunteers who will be happy to call. We seek to care for the emotional and spiritual needs during a time when we may be feeling overwhelmed as individuals.These will be short-term and informal care relationships in order to provide quick and non-administrative connections.
Your answer
Do you have other needs or requests?
We hope to adapt as the needs of our community change.
Your answer
Are you in need of food?
We have a group of people who have donated food for those who have lost jobs or normally depend on meals from school. If you are in need of food, but don't have the financial means to purchase enough, please answer the questions below.
How many people are in your household?
Your answer
Dietary Restrictions, Allergies, or Intolerances?
Halal, kosher, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc.-- this is important in case we're trying to substitute an item you asked for that's out of stock with something that is available.
Your answer
What meals do you need food for primarily?
Release of Liability
By submitting this form you understand that we are not professional counselors, and these are all volunteer attempts to help support you during this time. You agree to hold harmless CityLight Vineyard Church, their agents, employees, and volunteer assistants at all times during the terms of this agreement or any hold-over period for any and all claims, losses or demands for injuries, illnesses, or death to persons and/or damages to property arising from any support we offer including reasonable attorney fees and costs.
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