LIC Response & Support [Intake]
Email *
Recommended Form Useage
If you are unable for any reason to leave your apartment/home, please reach out for assistance, particularly if you:
- Immunocompromised, disabled, older or a senior
- Have difficulty with mobility
- Have other health conditions that may be worsened by going outside
- Are a healthcare professionals who have been quarantined due to work-related exposure
Our Safety Guidelines & Delivery Protocol
Our team of volunteers are committed to both the safety of your health and your security/privacy.
Unless given expressed permission by you, our volunteers will NOT be entering your apartment. All deliveries will be left at your door. Any needs that may require a transaction (e.g., picking up a pet for a walk) will be discussed and determined between you and your volunteer. Our priority is that you remain safe.

If possible, our team will wear latex/rubber gloves and masks during deliveries, along with carrying sanitizer. We are asking all volunteers to follow the following guidelines:

- Washing hands frequently with soap and water for a minimum of 20 seconds or using hand sanitizer
- Refraining from touching their face after having been outside
- Sneezing or coughing into their elbow
- Practicing “social distancing” -- staying indoors, avoiding crowds, staying 6 feet away from other people if you have to go outside

Volunteers will make as minimal contact with the recipient as possible upon delivery:
- They will place items at the door and knock/ring the doorbell and/or call the recipient to inform them that their order has been delivered.
- If items have not already been paid for, payment to the volunteer will be exchanged either via cash, check, or Paypal/Venmo/Cash App/Zelle (which can be done by slipping under the door or via a phone or computer).

***If you are receiving deliveries and may need to open the door for any reason, we ask that you wear protective equipment such as a mask and/or gloves, if possible
Full Name *
Preferred Pronouns *
Preferred Method of Contact *
Required
If Phone or Text, please provide your contact number:
Street address (if uncomfortable, write cross streets) * *
This will help us map our support across this network and connect volunteers to hyper local needs. Please note that if you need a delivery made, we will need your exact address. We will not share your information beyond our volunteer team.
Please let us know what your preferred language of communication is. *
We will do our best to match you with a volunteer who shares your language skills.
Are you experiencing COVID-19 symptoms? (Fever, dry cough, shortness of breath/difficulty breathing, sore throat). We will not refuse to support people who are displaying symptoms! This is so that we can help monitor at-risk people with symptoms *
To the best of your knowledge, have you been in contact with anyone diagnosed with or experiencing symptoms of COVID-19? *
What are your immediate needs? Check all that apply. For help with delivery services, we also recommend using Invisible Hands Deliver as a resource: https://www.invisiblehandsdeliver.com/request-a-delivery *
Required
Anything else you would like to add?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy