CCA Supply Bank - Doorstep Donation Form
Carterton & Brize Coronavirus Community Support Group

Hunger isn't something anyone should have to worry about in the middle of a global pandemic. As the crisis has developed, people have found themselves out of work, isolated, and in need of desperate supplies that they can't afford, let alone get out to buy.

We desperately need your help to keep local families fed. The CCA Supply Bank gratefully accepts donations of food both non-perishable, fresh and frozen. Long life items that are always helpful include:


- Hand sanitiser and hand soap
- Cleaning products
- Toiletries and feminine hygiene products
- Baby supplies such as nappies, wipes and food
- Calpol (or unbranded equivalent) and paracetamol
- Dried pasta, rice, grains and cereal
- Tinned and jarred goods of all kinds, especially fruit, vegetables and sauces
- Books for a book bank
- Pet food
- Hay and straw for ruminant pets
- Allergy-suitable food such as gluten-free pasta and soy milk

We will be carry out regular socially distanced collections by asking donors to leave their items securely in a safe place that our volunteer can retrieve it from without coming into contact with you. Please use the below form to provide details of your safe place and select your preferred collection date.

If you have FRESH/FROZEN goods to donate, please enter instructions such as "Please knock on arrival and I will get from the fridge then leave on step" and DO NOT leave them out for the whole time slot as we won't be able to accept them.


If you display symptoms between submitting this form and the collection date, please urgently contact Josh Grace or Marion Harley to cancel your collection.

Stay safe. Stay at home. Wash your hands.
Name *
Address Line 1 *
House Number and Name and Street please separated by a comma. Example: 123, New Road
Postcode *
Contact Number *
In case of a problem with collection
I will leave my donation in the following safe place... *
Please provide as short but accurate a description/instruction as possible
I'd like my donation collected on... *
My donation includes the following items: *
Safeguarding: COVID-19 *
To help reduce the risk of potentially transmitting COVID-19, we ask that donations are not made if you are self isolating or are showing any symptoms at all. If you are, please keep hold of the items and contact us when your isolation has been completed.
Safeguarding: Dogs *
We ask that you help keep our volunteers safe by ensuring there is no possibility they will be attacked by dogs on your property.
Additional Notes (optional)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy