Have a Need
We know that many people will have needs they cannot meet on their own during the "Shelter in Place" mandate. Please complete this form to communicate any essential needs you have during this time. Please be as detailed as possible to ensure we can connect you with the right person for aid.
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What is your date of birth (mm/dd/yyyy)
What is your affiliation with Golden Hills?
Do not attend
Please provide your house number, street name, city, state, and zip code i.e. 123 Elm St. Oakley, CA 94561
Phone Number (xxx) xxx-xxxx
What type of need do you have? (check all that apply)
Baby Supplies (diapers, wipes, formula, etc.)
Household Items (toilet paper, facial tissue, household cleaners, etc)
Personal Care (Feminine and Personal hygiene products, over the counter Medicine, etc)
Remote Pastoral counseling
Please provide a brief description of the specifics of your need.
Where will this need be fulfilled?
Please write alternate address in "Other..." field if different than above.
Same address as above
What days are you available?
What time of day you are available?
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