Winter Transport Availability
IMPORTANT - Thank you for your kindness to our unhoused neighbors. By signing this form, you are indicating interest in being connected with people in need of transportation. Please note that by signing this form, you are not obligated in any way to provide any services listed, and you are accepting full responsibility for yourself and your property, any passengers and any resulting liability. No participating organization shares that responsibility with you.
In Google anmelden, um den Fortschritt zu speichern. Weitere Informationen
E-Mail-Adresse *
First Name
Last Name
Phone Number
Back-Up Phone Number
How did you hear about us?
Do you currently have power in your home?
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What zip code do you live in?
What kind of vehicle do you drive? (Please include details like 4-wheel drive)
How many people does it seat?
How many miles do you estimate you have left? (Please consider the gasoline shortage and your personal needs.)
Please select all that apply regarding your availability.
Please select all of the services you are comfortable providing.
Is the vehicle you will be driving registered and insured?
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Has your driving record been clean for the last 2 years?
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Senden
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Geben Sie niemals Passwörter über Google Formulare weiter.
Dieses Formular wurde bei Workable World Consulting erstellt. Missbrauch melden