Volunteer Match Form

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The Cummington Area Community Emergency Response Team (CERT) is working on a coordinated community response to the COVID-19 pandemic. Please complete the following form to let us know how you would like to help.

First Name *

Last Name *

Phone Number *

Email address

Are you an active Cummington Area CERT Team Member? *

Yes

Inactive member (took training, didn't test)

Are you a Cummington resident? *

Yes

No (If no, please list your town in Other)

Other:

Required

What type of support are you able to provide? *

1:1 check-in phone calls and/or video chats

Picking up prescriptions

Picking up groceries

Curbside deliveries (no contact)

Financial donation

Food donation

Supplies donation (medical, cleaning, other non food goods)

Other:

Required

Please list any other skills and resources you think may be helpful.

What is your ability to provide support? *

Rapid response (1-2 hours)

Pre-planned response (24-48 hours)

I can't provide support, but would like to help in another way (list in Other)

Other:

Required

I agree.... (both boxes must be checked to volunteer) *

I am signing up for Volunteer match with Cummington Area CERT coordinated community effort of my own free will.

By checking this box, I attest the content of this form is true, and I agree to accept all risk and responsibility associated with my decision to offer help.

Required

Thank you for volunteering to help! We will be in touch as we are able. You can also email us at CummingtonCERTCVHelp@gmail.com.

Please use this form in part or whole to help your community. Email Lee at cummingtoncertcvhelp@gmail.com for direct share of template.

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