Red Hook Coronavirus Community Support Survey
Dear Neighbors,

Red Hook will need your help in the coming weeks. Let's stick together to talk about how we can best prepare for and help each other if the virus affects our building/block/neighbor. We can talk about guidelines for sanitation, safety, and prevention and how to organize to access supplies and help neighbors in need. If you are a medical or mental health professional, or you have experience in disaster relief personally or professionally, your knowledge and skills are especially valuable. Please fill out this form if you are interested in joining a meeting or volunteering, give times you are available, and fill out all relevant fields.

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First and Last Name *
What is your address? *
What is your cross street? *
If not Red Hook, where do you live? *
If you do not live here, what is your relationship to Red Hook?
Email address (Gmail if possible to receive calendar invitations) *
Phone number (XXX) XXX-XXXX *
Does this number accept text messages? *
Meeting formats you can participate in *
What day(s) of the week are you available? *
What times are you available? *
Do you have any medical skills, training, or certifications? Please explain. *
Do you have any disaster training or experience? Please explain. *
Do you have any experience with team organization and management? Please explain. *
Do you have any military experience? Please explain. *
Are you over the age of 50? *
Do you have children or anyone over 50 living with you? *
Do you or does anyone who lives with you have any kind of breathing or lung condition or disease?
Clear selection
Do you or does someone in your home smoke?
Clear selection
Do you have a bicycle? *
Are you a single parent?
Clear selection
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