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.
What is your date of birth? (mm/dd/yyyy)
What is your affiliation with Golden Hills?
Do not attend
Please provide your house number, street name, city, state, and zip code i.e. 123 Elm St. Oakley, CA 94561
Phone Number (xxx) xxx-xxxx
Disclaimer: I agree to donate any relief I provide.
What relief can you provide?
Baby Supplies (diapers, wipes, formula, etc.)
Household Items (toilet paper, facial tissue, household cleaners, etc)
Personal Care (Feminine & other personal hygiene products, over the counter medicine, etc)
What days are you available?
What time of day you are available?
How far are you able to travel to provide relief?
Please consider the "Shelter in Place" regulations when answering below
Within my own city
In my city and neighboring cities
Within Contra Costa County
As far as needed
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