Emergency Delivery Drivers
La Casita and our partner organizations need your support to get essential items delivered to members of our community. You can help by picking up items from donor's porches and delivering them to the homes of those in need--0 social contact necessary.
Please note that safety and preventing the transmission of the coronavirus are of utmost importance to us. Please review the questions below regarding precautionary practices. If possible, bring hand sanitizer and lysol wipes along with you during deliveries to disinfect yourself, the package, and your car!
with any questions!
Phone Number/ Numero de Telefono
Zip Code/ Codigo Postal
Are you willing to make additional solidarity purchases from grocery stores or pharmacies in cases of emergency needs for items like tylenol, advil, cough syrup, etc? / Estas dispuestx hacer compras adicionales como medicamentos, etc?
Willing to shop but cannot pay/ Dispuestx a comprar pero no puedo pagar
Are you considered high risk of getting very sick from COVID-19 OR are you frequently with others who are so considered? See checklist below. We promise to communicate when you are delivering to a home with a confirmed case of COVID so that you may opt out of it--but we cannot be sure of everyone. / Te consideras de alto riesgo para el COVID o estas frecuentemente con personas de altos riesgo?
Older adults/ Adultos mayores
Individuals with chronic conditions such as heart disease, diabetes, and/or lung disease/ Individuos con condiciones de salud cronicas
Individuals with compromised immune systems/ Individuos con sistema immune comprometido
None of the above/ Ninguna de las anteriores
Fully Vaccinated/ Completamente vacunadx
Do you agree to confirm to all recommendations for preventing the spread of coronavirus, including but not limited to: frequent 20-second handwashing practices, use of hand sanitizer, wearing a mask, not shaking hands, not touching your face, coughing into a tissue or your elbow, staying home when you are sick?
What is the likelihood that you have been exposed to COVID-19 and/or are carrying the virus?
High (If high, please do not sign up to drive. We wish to protect the health of all community members at this time. Include your email address at the bottom of the form to be contacted about future ways to connect!)
If you would like to be added to La Casita's mailing list for future information, please write your email here.
How did you hear about La Casita Center? This question better helps us understand Louisville's support networks. Use specific names if possible!
By entering your name here and submitting your form, you are hereby releasing La Casita from all liability from dangers relating to driving and possible risk of virus transmission. You understand that your name and phone number will be added to a list of drivers who may be contacted during normal hours (8a-8p) regarding deliveries. You may respond with a request to opt off at any time.
Somos un circulo. We are a circle.
Your solidarity and willingness to support the Latinx community during these times is deeply appreciated - there are no words to fully express our gratitude. We are happy to join with you in meeting this challenge through love and compassion.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service