Vulnerable Individuals in Hampden & COVID-19
Hampden's COVID-19 Response team is made up of your neighbors who would like to help you stay well. We'd also like to help you shelter in place if you're exhibiting COVID-19 symptoms, have possible exposure, or are worried about compromising your immune system. Self-quarantine is recommended for 14 days for those who may have had exposure to the virus, and for 72 hours after symptoms end.
Please fill out the form below to be paired with a neighbor close-by who can help out. We can help with activities outside of the home.
If you know of an older adult or immune-compromised neighbor that doesn't have access to the internet, please fill out this form with their name and phone number or address so someone from the team can check in with them.
*No information will be shared outside of the Hampden volunteer community
I need help with:
Grocery pickup and delivery
Prescription pickup and delivery
Social/ emotional support by phone
WAIVER: We are all living with risks associated with the novel coronavirus (COVID-19). In our efforts to respond, we are all doing our best to mitigate that risk. It is necessary for you to understand that participation in the SQSN includes interactions that may be hazardous to those involved. There is risk involved in acting as a requester through HCC's SQSN. As such, we ask that you sign the following waiver. By submitting this form, I declare that I understand and agree to the following terms: I, the undersigned Requester of Services through the SQSN, release and hold harmless the organizers and/or coordinators of the SQSN and its successors (ie, HCC board members, Plat coordinators, or committee members) and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arises contemporaneous with or might hereafter arise from my request of services with the HCC SQSN committee. I, the undersigned Requester of Services, understand that this Waiver of Liability discharges the HCC and its successors from any liability or claim that I, the Requester of Services, may have against the HCC with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation as a Requester of Services for the HCC SQSN committee efforts in the community. I also fully understand that the organizers and/or coordinators of the SQSN do not assume any responsibility for or obligation to provide financial assistance or other assistance (including but not limited to medical, health, or disability insurance) in the event of any injury, illness, death, or property damage. I, the undersigned Requester of Services, understand that I expressly waive any such claim for compensation or liability on the part of the organizers and/or coordinators of the SQSN beyond what may be offered freely by the President of the HCC in the event of such injury or medical expense. I, the undersigned Requester of Services, expressly agree that this Waiver of Liability is intended to be as broad and inclusive as permitted by Federal laws and the laws of the State of Maryland, and that where there is any conflict of laws this Waiver of Liability shall be governed and interpreted in accordance with the laws of the State of Maryland. Checking “I agree” shall constitute your signature of the foregoing Waiver of Liability.
I disagree (no services will be provided)
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