QA Coronavirus (COVID-19) Assistance
"Officially" which community are you in *
Which of the following brings you here? (You can choose multiple) *
Required
Privacy: Please indicate that it is okay that your answers are shared with the 5 core members of the QA COVID committee. The information will be kept secure and confidential between these members. *
Name (First, Last) *
Your answer
Your Address (Street Address, Postal Code) *
Your answer
Your Phone Number *
Your answer
Your Email Address (If Available)
Your answer
General Age Group
If you indicated that YOU WOULD LIKE SOME ASSISTANCE with tasks, which areas do you want support with? [NOTE, if you are here to volunteer or get on the email update list, choose first option) *
Required
Please select one of the following that best describes your current situation. This information is only to make sure we make the best matches between people and approach. *
Required
Anything else we should know? If you have information that might help us better understand your situation, type it below. If you have special needs, indicate what they are below.
Your answer
Would you be interested in strategies to reduce exposure to individuals, such as "pooled-shopping" for residents of all risk groups? *Pooled-shopping means one resident trained in decontamination measures shops and delivers to a few residents, to reduce numbers of individuals in public spaces.
If you indicated that you WOULD LIKE TO VOLUNTEER , which areas can you help support? [NOTE, if you are here to receive assistance or get on the email update list, choose first option]
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This form was created inside of Queen Alexandra Community League.