Houghton Regis Mutual Aid Volunteer Registration Form
Please fill out this form if you are willing and able to offer local support to your neighbours who are self-isolating, elderly or otherwise vulnerable.

Houghton Regis Mutual Aid Community Action Group (COVID-19) is a grassroots community group volunteering support for neighbours during the COVID-19 outbreak.

Please do not upload information on behalf of others. Please do not upload any sensitive information.

The information captured by the Google Form will be used for the legitimate purposes of the group - to connect volunteers working in the same area, and to match volunteers to members of the community seeking support. We will not store data from community members seeking support.

Any information gathered will be deleted when the group disbands.

To remove your data or ask any questions please email: HoughtonRegiMutualAid@gmail.com
Email address *
Clear selection
Name *
Address *
Phone Number
What kind of support can you offer? *
If you answered "anything else" on the previous question please provide a little more detail here:
We would like to focus volunteers into smaller areas, please choose any areas that you would be able to volunteer in? *
Do you have an up-to-date DBS clearance? (this may not be absolutely necessary for everyone but it's handy to know)
Clear selection
Do you have any other specific skills or qualifications that you think might be useful for this? Please supply a little detail here.
By clicking submit you agree for your data to be stored by the volunteer group for Houghton Regis Mutual Aid purposes only. Please select your consent of data sharing. You can withdraw consent at any time by emailing HoughtonRegisMutualAid@gmail.com * *
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