Collection Request Form
Please fill in this form to request a collection of items for distribution by the Harrogate Scrubbers

The admins of the Harrogate Scrubbers group will hold your information for the purpose of allocating, delivering and receiving scrubs for the Harrogate Healthcare Community only. We may share information with volunteers for this purpose, but data will not be stored or used for any other reason. We will delete your data at the end of the project
Name *
Address *
Postcode *
Landline phone number
Mobile phone number
Which is your Hub? *
What do you need collecting? *
Are you a member of the Harrogate Scrubbers Facebook group?
Clear selection
Any comments for the person collecting your items? (eg. location, timings, etc)
If you are asking for scrubs collection, please answer the following:
Were the scrubs made using a Harrogate Scrubbers bundle?
Clear selection
What size are they?
Clear selection
How many complete sets are there?
Any additional comments?
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