I need help (regretfully we cannot accept new applications, filling out this form puts you on the wait list)
Are you in need of supplies or support?
If you are within a 30 minute drive from Playa del Rey (zip code 90293) or have URGENT needs use this form. If not please sign up at www.mutualaidla.org
Please tell us your name *
Please tell us what you need (please be as specific as possible e.g. groceries, household goods, baby supplies) *
Please tell us your phone number *
Please tell us your email address *
Please tell us your address or cross streets *
Please tell us the best time to deliver to you!
9am - 1pm
1pm - 6pm
6pm - 9pm
Please tell us your or household income *
Please tell us your age *
Please tell us how many people are living off the income *
Please tell us about your housing *
Would you like to volunteer?
If so go to GrassRootsNeighbors.org and sign up
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