As a low-risk individual, I want to volunteer and offer assistance.
Ashton Heights Buddies will match one low risk individual/family with one high risk individual/family or others in Ashton Heights requesting assistance. We in are working to help those who are at greater risk of developing serious complications from COVID-19. Volunteers can help high-risk neighbors meet basic needs and/or provide check-ins. For the purposes of this form, individuals who are considered low-risk include those who are under 60 years of age, who do not have compromised immune systems, and who have not been advised by a physician to self-isolate.

Once a match is made, you and your buddy can coordinate your interaction. This could consist of the delivery of essential supplies, such as food, toiletries, and prescriptions. You and your buddy can also help one another feel less isolated by checking-in on the phone, texting or other electronic means. Please follow all directions provided by the CDC to mitigate spread of the virus.

We will match you with someone in Ashton Heights as soon as a buddy requesting assistance becomes available. We will do our best to meet all requests but cannot guarantee a buddy match.

This match program is being organized by private citizens for the benefit of those in our Ashton Heights community. By completing the sign-up form to be matched you agree that you accept all risk and responsibility and further hold any representative associated with Ashton Heights Buddies or the Ashton Heights Civic Association harmless. For any additional questions, please contact AshtonHeightsBuddies@gmail.com
Name: *
Email Address: *
Phone Number: *
Can you receive text messages at the above phone number? *
If no, please provide an alternative number for texting:
Preferred method of communication: *
Do you live within the boundaries of Ashton Heights (between North Glebe Road and North Irving Street; and between Wilson Blvd. and Route 50)? *
If no, please specify your neighborhood:
Closest cross streets to your residence? *
Please do not provide your exact address.
Zip Code: *
Are you willing to be paired with one high-risk individual to assist them until the end of the social distancing period and/or until one individual decides they would like to stop working together? *
What can you assist with? Please select all that apply. *
Required
Any other details you'd like to share on how you can provide assistance to your buddy? *
Do you have consistent access to a car? *
Are you proficient in any language other than English?
Do you agree to have your contact information (phone or email only, your address will not be given out) shared with the individual who will serve as your buddy for the assistance you are offering to provide? *
Waiver: By clicking "I agree" below, I certify that I am at low-risk of developing serious complications from COVID-19, as determined by the CDC and that, I agree that I would like to be contacted by Ashton Heights Buddies to receive a buddy match. I also agree that I accept all risk and responsibility and further hold any representative associated with Ashton Heights Buddies and the Ashton Heights Civic Association harmless. * *
Required
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