Referral for 'Church Chat and support' - all areas of the UK
Hello! Do you need support or a friendly chat while isolating? Your local Church is ready to help!

This electronic form acts as referral for a person who is self-isolating due to COVID-19 (CoronaVirus), or those who are over 70 or in a health-risk group and therefore isolating, and in need of some extra friendly support.

Please complete for yourself or ensure you have permission from the person you are completing the form for. Only Priests or Ministers in charge of a church will receive your details and they will pass it on to a person with a DBS (safeguarding check) to support. The contact details will only be kept for 16 weeks from this form being submitted.

Anything that needs to be fetched will be left outside or posted through the letterbox. At no point will a support person enter your home.
Are you/ is the person you are referring self-isolating due to symptoms of COVID-19 (CoronaVirus)? *
Name *
What support do you require?
Would you prefer support from a female or male?
Clear selection
Phone number *
By ticking this form you are confirming that you are consenting to Buxton Team Parish holding and processing your personal data for the purpose of support listed above (according to rules of GDPR). The details on this form will be destroyed in 16 weeks from the date of submission. You can find out more by phoning 01298 212 667 to speak to Reverend Liz. I consent to the Buxton Team Parish contacting me by the details above: *
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