Cherry Burton COVID-19 Support Group Request for Assistance Form
Form to be filled in if you are requesting some community support or assistance.
Name (what you want to be called?)
Phone Number (Home/Mobile)
What assistance would you like?
Someone to help with shopping (food, medicine)?
Emotional Support (phone)?
Emotional Support (face to face at your door - subject to Coronavirus restrictions)?
Are there any specific days/times when you require help?
Anything else you wish to share?
By clicking submit you agree for your data to be stored by Cherry Burton Parish Council for Cherry Burton COVID-19 volunteer aid group purposes only. Please select your consent to data sharing. You can withdraw consent at any time by emailing
Share my data with other local volunteers
A copy of your responses will be emailed to the address you provided.
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