Vulnerable Individuals in Remington & COVID-19
Remington's COVID-19 Response team is made up of your neighbors who would like to help you stay well. We'd also like to help you shelter in place if you're exhibiting COVID-19 symptoms or are worried about compromising your immune system.

Please fill out the form below to be paired with a neighbor close by who can help out. We can help with activities outside of the home.

If you know of an older adult or immune-compromised neighbor that doesn't have access to the internet, please fill out this form with their name and phone number or address so someone from the team can check in with them.

Questions? celesteperilla@gmail.com

First Name *
Your answer
Last Name
Your answer
Street Address
Your answer
Phone number
Your answer
Email address
Your answer
I need help with:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy