Kitsap Community Mutual Aid During COVID-19
This is an intake form to help community members ask other community members for support in Kitsap during the COVID-19 pandemic.  

Fill out the form below.

Your information will go into a Google document that will be shared publicly so that community members can offer assistance. Therefore, you are not asked here to share your specific location, just your contact information.  

Community members who read the document and think they can assist will then be able to contact you.  From there, you decide whether you want to take their assistance.  You are under no obligation to the person who contacts you in any way, and you are welcome to refuse or put conditions on their assistance.
This 8-minute video by Dean Spade and Ciro Carrillo explains mutual aid, including examples of mutual aid efforts:  (HEADS UP:  The title of the video is "Sh*t's Totally F*cked:  What Can We Do?"  The video itself isn't full of curse words, but the words in the title are spoken aloud at the beginning and a couple times during the video, just so you know.)

Mutual Aid projects:
*** are collective and collaborative
*** bring a *built-in* understanding of community and culture to the way we identify and dismantle harmful systems and to the way we ground each other in empowerment, solidarity, and witnessing
*** draw power/perspective from being horizontalist and inclusive
*** center engagement, practice, and skills-development
*** challenge disposability
*** are active
One person (Airen Lydick) set up this intake form and Google document, but this mutual aid effort will be run collaboratively by all who participate.  We are here together on the lands of the Suquamish, S'Klallam, and other Coast Salish people.  When we participate in this effort, we are collectively assuming the responsibility of making this work.  If there is a way you can add to the functionality, inclusiveness, and accessibility of this mutual aid form, please email  (For example, maybe you can help with translating this document into Spanish or other languages!)

To stay connected to Kitsap mutual aid efforts and planning, visit the Kitsap COVID-19 Support & Solidarity page on Facebook:  

To view the Google document where the information you are about to share will end up, follow this link:
Sign in to Google to save your progress. Learn more
What is your name?  (This does not need to be your legal name, just a way for people ask for you if they contact you.) *
Are you living on Kitsap Peninsula? *
During this time of COVID-19 physical distancing, in which general area are you "hunkering down"? *
Do you prefer people contact you by email or phone? *
What is the best email address for people to reach you?  (Enter whichever of your email addresses you're most comfortable sharing publicly.  If there's not one, just enter "none.") *
What is the best phone number for people to reach you?  (Enter whichever of your phone numbers you're most comfortable sharing publicly.  If there's not one,  000-000-0000.) *
Do you have a chronic health condition that affects your immune system? *
Have you had a flu-like symptoms, fever, cough, or shortness of breath in the past two weeks? *
What help do you need?  (Subsequent questions will gather details about your restrictions, allergies, sensitivities, etc.)
Your Dietary Restrictions, Intolerances, Allergies, etc. (halal, kosher, vegetarian, lactose-intolerant, gluten-free, allergic-to-________, scent sensitive, have MCS, etc.  Sharing these details helps another person know if they're in a position to help you out.)
If you need companionship, some human interaction with physical distancing, please check all of methods you're willing to try.
Do you have other needs or requests for assistance not covered above?  Please describe briefly.
Do you have additional specifications, accessibility needs, etc. that a person responding to your request for assistance would need to know?
Is there an "expiration date" on your request for assistance, i.e. a date after which you don't want to be contacted about this?
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