North Valley Mutual Aid - COVID19 - VOLUNTEER FORM
We are coordinating food and supply drop offs to people's front doors. Please use this form if you would like to help make deliveries. Thank you!!
We are prioritizing folks who are sick, disabled, quarantined without pay, elderly, undocumented, queer, trans*, Black, Indigenous, and/or people of color. Thank you for your patience and grace.
Please make a check next to all potential supports that you have the capacity to provide. All offers of support will be kept confidential until a need arises. These are non-binding, but more to get a sense of the abundant resources we do have. At the end, please also tell us about potential situations where you might need assistance, so we can start to match up potential needs with potential offers.
Questions, updates or want to get involved?
Join the google group for announcements:
If you'd like to help, please see this survey results google doc link below and mark you name in column Q if you are going to contact to help that person:
A Chronic Illness Patient's Guide to Coronavirus:
This does not need to be your legal name. And add your pronouns if you want too!
How should we contact you?
Please include your phone number, email, and/or Facebook messenger -- give several options if possible.
Do you have access to a vehicle?
[Image of a red cartoon car]
I can provide the following supports: (Remember, this is non-binding. Please check all that apply)
Picking up and delivering groceries, medicine or other essentials
Making doctors appointments, calling about medication refills, similar scheduling tasks
Picking up prescriptions
Signing people up for health insurance
Check in on elderly and/or disabled relatives nearby
Emotional support (e.g. talking over the phone with someone who's worried)
Medical response and first aid
Spare bed or comfortable couch
Translation (Please list language under the "Other" option below)
De-escalation, conflict resolution, peace-building skills
Religious/Spiritual ministry (please list faith tradition below in the "Other" box)
I can help donate to a common resource fund
Are you 21+ with a valid ID?
[Image of an ID Card with the face of Spongebob on it, and Bikini Bottom as the State]
Would you like to help pay for the groceries / supplies?
We want to ensure that those who want to provide mutual aid do not face undue burden and we absolutely do not expect you to spend money if you are financially limited.
No. I will need money ahead of time in order to buy the groceries.
No. I have the money to make the initial purchase, but I will need reimbursement.
Yes. I have the money to make the initial purchase & can donate some, but I may need reimbursement eventually.
Yes. I will donate any groceries or supplies I pick up.
What type(s) of money transfer work for you?
If you marked any meal prep options above, please list any particular cuisines that you are used to cooking (e.g. Somalian, Italian, Vegan)?
What neighborhood or town do you live in?
What languages do you speak?
Where do you prefer to deliver?
[Image: Map of Butte County listing towns in the area]
Do you have any accessibility needs you want to share, or need anything else to feel safe providing deliveries?
A buddy to do deliveries with
Help acquiring hand sanitizer/wipes
Generally, what times are you available?
You may also leave more specific day and time schedules in the "Other" write in box.
Any additional specifications, comments, or questions?
Thank you again for taking time to fill out a support form! We will contact you if and when we match you with a request.
Send me a copy of my responses.
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