Olympia COVID-19 Request Support Form
If you would like food or other supplies dropped off at your front door, or would like to request other forms of support in the Olympia area, please use this form.

We are an all-volunteer grassroots group operating in Nisqually and Squaxin Island territories. As a small group, we are not offering direct support, but helping to connect people who can offer support with those who need it. 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.

If you would prefer to e-mail us rather than using this form, you can e-mail us at:

olympiacommunityresilience@gmail.com
or:
olycommunityresilience@protonmail.com 

Joy and solidarity over fear and isolation!
Sign in to Google to save your progress. Learn more
Name and pronouns *
This does not need to be your legal name. Add your pronouns, if you want.
How should we contact you?   *
Please include your phone number, email, and give several options if possible, list in order of convenience.
How many people are in your household?
Do you need translation/interpretation services? Please list which language.  
Dietary Restrictions, Allergies, or Intolerances
Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock
What types of food do you want?
Grocery List
Items can be general like "milk," or specific like "a 24-pack of the purple Always brand overnight menstrual pads with wings." We will do our best to match your requests, but if we can't find something specific we may get you a similar substitute. We trust you to know your needs and we are committed to delivery without judgement
Do you need someone to pick up your prescriptions for you? If yes, which pharmacy?
Please either give a phone number/Signal option so we can reach you (this option is safer) - OR - include all relevant info here, like your legal name, date of birth, and the names of the medications (Google forms are not secure!)
Delivery address: *
What day and time do you need things by? Please allow us 48 hours to respond to your request. * *
We can't guarantee timing but we will try our best
Do you need laundry, pet sitting, transportation help, or childcare? Please describe.
Any additional specifications, comments, questions, accessibility needs, or drop off instructions
Please check all that apply
We want to prioritize vulnerable populations, if you feel comfortable please let us know a little bit about yourself
Do you have any feedback or other questions? *
This is a group effort, so any feedback would be greatly appreciated. Feel free to add any additional questions or comments here!
Are you able to pay for supplies? *
We can’t guarantee that we will have funding available but we will do our best to help you get the resources that you need or to connect you with other resources if we are unable to fulfill your requests.
How are you able to pay or reimburse volunteers? *
Please list as many options as possible. (cash, cashapp, venmo, PayPal, Apple Pay, EBT, etc)
We will try to let you know if we can meet your request within 48 hours. We are so glad you've reached out to us for support.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms