Pomona, Ontario, Montclair Mutual Aid Intake

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Pomona Mutual Aid Network is a collective of community organizers, teachers, students, youth, and workers coming together to support those most communities who have been most impacted during the COVID-19 health crisis. The working class, low-income, poor, undocumented, disabled persons, LGBTQ+, immunocompromised folks face the gravest challenges during this time. We can provide support for food or supply drop-off, transportation, monetary assistance, mental health, and navigating social services. The Pomona Mutual Aid Network comes from a long tradition of solidarity, not charity.

We will take adequate safety measures, such as wearing masks and gloves for drop-off, disinfecting supplies, and keeping safe distances.

If you are in need of assistance following the COVID-19 outbreak please fill out the following survey. The information you provide will be shared with volunteers so they may contact you if they are able to help. To maintain privacy, your name is not required to accept aid. We only ask for minimal information regarding health conditions so we can keep our volunteers safe and prepared.
English VOLUNTEER forms (https://docs.google.com/forms/d/e/1FAIpQLSd1dO3DpMOyvGSLUXtgFB6BytIVW0vNtQRRmwKu7siRSv3Q1w/viewform?usp=sf_link)

Formulario de ADMISON en Español (https://docs.google.com/forms/d/e/1FAIpQLSeQpJpGHjs_biwsj9vMowfFIpn2sfxmllt4Mj4JIztac6jAaQ/viewform?usp=sf_link)

Formulario para VOLUNTARIOS en Español (https://docs.google.com/forms/d/e/1FAIpQLScm7FsdgIOZI1vQwIybfskyUNuQ5Mng3h7VlPOXM32EMyh_EQ/viewform?usp=sf_link)

Please consider donating to our Pomona Valley Coronavirus Emergency Fund: https://www.gofundme.com/f/pomona-mutual-aid-emergency-relief-fund?utm_source=customer&utm_medium=copy_link-tip&utm_campaign=p_cp+share-sheet

DISCLOSURE: The host of this document cannot guarantee that all requests for aid will be met but is simply a community member offering to share a document and allow others to help each other. Please be responsible when arranging to meet with folks you have not met. The hosts accepts no liability around these engagements. Please note that we do not offer childcare services; however, we can refer you to groups that can provide this support. If you need childcare, please indicated below on this form.

Please email PomonaMutualAid@gmail.com to have information removed or changed.
Phone: (909) 278-8164‬

Name and pronouns (they/them, she/hers, him/his, etc)

Where are you located?

How can we best contact you? ( Please include your phone number or email)

Are you hard of hearing / Deaf and need someone who uses ASL? * Do you have any disability you would like to share so we can accommodate accordingly.

Do you have specific limited/dietary restrictions, limited or food allergies? (allergies to peanuts, gluten, seafood, vegan or vegetarian diet)

Do you have reliable transportation? (not required)

Yes

Clear selection

Are you older than 60 years old?

Clear selection

Do you have a chronic health condition that affects your immune system? * If so, please explain so we can accommodate accordingly.

Have you had fever or flu like symptoms in the last week?

yes

Clear selection

I am seeking assistance for:

Picking up and delivering groceries, medicine, or other essentials

Transportation to medical facilities (to avoid public transit/ride shares)

Extra medical supplies (list below in OTHER)

Cleaning supplies or essential items while out of work / income reduced

Home cooked meals

1 on 1 phone calls / video chats / home visits / companionship

Assistance navigating and advocating to social services

Other:

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