COVID-19 Supply Delivery Driver Info
Delivery Driver Contact Form
Email address *
Approximately how long has it been since you have used any form of public transportation? *
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)? *
Have you been in contact with anyone with a confirmed case of COVID-19 or showing symptoms of COVID-19? *
Are you exhibiting any of the confirmed COVID-19 symptoms (e.g. cough, headache, fever, shortness of breath) consistent with NIH guidelines? *
What services would you be able to provide? *
Full Name *
Town/City of Residence
Maximum time from home willing to deliver (one-way)? *
Phone Number *
Type of Vehicle *
Do you have insurance on your vehicle? *
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 (for our insurance purposes). Please briefly explain a "No" answer to this question when you send in your license.
Days/Hours Available to Volunteer *
Morning (8am-noon)
Lunch Break (noon-1)
Afternoon (1pm-5pm)
Evenings (5pm-8pm)
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