COVID-19 Supply Delivery Driver Info
Delivery Driver Contact Form
* Required
Email address
*
Your email
Approximately how long has it been since you have used any form of public transportation?
*
Choose
Less than a week
1-2 weeks
2-4 weeks
1-2 months
More than 2 months
Approximately how long has it been since you have visited a high risk zone in the US (e.g. Boston, Washington State, New York City)?
*
Choose
Less than a week
1-2 weeks
2-4 weeks
1-2 months
More than 2 months
Have you been in contact with anyone with a confirmed case of COVID-19 or showing symptoms of COVID-19?
*
Yes
No
Are you exhibiting any of the confirmed COVID-19 symptoms (e.g. cough, headache, fever, shortness of breath) consistent with NIH guidelines?
*
Yes
No
What services would you be able to provide?
*
Grocery Shopping
Required
Full Name
*
Your answer
Town/City of Residence
Your answer
Maximum time from home willing to deliver (one-way)?
*
Choose
5 minutes
10 minutes
15 minutes
20 minutes
30 minutes
Greater than 30 min
Phone Number
*
Your answer
Type of Vehicle
*
Choose
Hatchback
Truck
Wagon
Sedan
SUV
Other
Do you have insurance on your vehicle?
*
Yes
No
Do you have a clean driving record (no moving violations) for the past 5 years?
*
After you submit this form, you will be asked to submit a photo of your driver's license to
keenehelpers@gmail.com
(for our insurance purposes). Please briefly explain a "No" answer to this question when you send in your license.
Yes
No (Please explain when you submit license image)
Days/Hours Available to Volunteer
*
Morning (8am-noon)
Lunch Break (noon-1)
Afternoon (1pm-5pm)
Evenings (5pm-8pm)
None
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Morning (8am-noon)
Lunch Break (noon-1)
Afternoon (1pm-5pm)
Evenings (5pm-8pm)
None
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Submit
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