Offer Relief
Since many will need relief during the "Shelter in Place" mandate, please use this form to communicate how you may be able to provide for someone else's needs. You will be connected with someone who has reached out with a need.
Email address *
First Name *
Your answer
Last Name *
Your answer
What is your date of birth? (mm/dd/yyyy) *
Your answer
What is your affiliation with Golden Hills? *
Address *
Please provide your house number, street name, city, state, and zip code i.e. 123 Elm St. Oakley, CA 94561
Your answer
Phone Number (xxx) xxx-xxxx *
Your answer
Disclaimer: I agree to donate any relief I provide. *
Required
What relief can you provide? *
Required
What days are you available? *
Required
What time of day you are available? *
Required
How far are you able to travel to provide relief? *
Please consider the "Shelter in Place" regulations when answering below
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