We support Selly Oak - Those who are in need of support!
HELLO!
This form is for those who are self-isolating, we can help!
We want to make sure you are equipped with necessary food and supplies or just a friendly person to chat to.
All our information is on our page
Facebook:
If you have any questions: contact our page on facebook (link -
https://www.facebook.com/groups/552874341990946/
)
or
Reece Roberts - 07810671395
Sarina Shah - 07984258454
ALL DATA WILL NOT BE SHARED AND DESTROYED UPON REQUEST AND AFTER COVID-19 IS DONE!
Name
Your answer
Age
under 18
18-30
30-50
50 - 70
70 plus
Clear selection
Address
Your answer
Contact details
Your answer
If you are self isolating, we can help with
Delivering post
Picking up shopping (left outside door)
In need of urgent supplies
friendly person to call
pick up and drop off prescriptions (left outside door)
Clear selection
Submit
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