COVID-19 Care Survey - Church of the City
As a church family, we aim to come together as the body of Christ to care for those who are most affected by providing spiritual, emotional, and practical support during this difficult time.

The purpose of this form is to find out 1) who can help, and 2) who needs help.

For those who are more significantly affected by COVID-19 and need help, we want to gather the necessary information about your circumstances so that the church can know how to serve you.

(In order to protect your privacy, your information will be accessible to only a subset of the COVID-19 Response Group who will coordinate the support and will share your information on a limited need-to-know basis with the Care Team and Prayer Team. Email with any questions.)
Are you able to help or do you need help? *
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Street Address
Your address will be used to connect those who can help to those needing help who live in the same neighborhood.
Your answer
Apartment Number
Your answer
Zip Code
Your answer
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