East Sooke Together - Client Intake
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Email
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Your email
Preferred First Name
Your answer
Phone number and email
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Preferred contact, email or phone? If possible, email is a little easier for us.
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Email
Phone
Your closest neighbourhood
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Becher Bay
Seedtree
Mount Matheson
Park Heights
Anderson Cove
Coppermine
Seagirt
Eliza Point
Tideview
Gillespie
Pike Road
East Sooke Road - select the nearest neighbourhood
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How can we help? REMEMBER: Do not share your personal bank or debit information with anyone.
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Essential Grocery Shopping/ Medical Supplies/ Prescription Pick-up
Regular, friendly phone call
Other:
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Is there anything else you would like to tell us?
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By clicking SUBMIT you agree to your data being stored by the volunteer group East Sooke Together (EST)*, for COVID-19 aid purposes only. Please indicate your consent for data sharing within this group. You may withdraw consent at any time by emailing
EastSookeTogether@gmail.com
or leaving a message including your name and phone # at 778-400-5442. (*EST is sponsored by the East Sooke Neighbourhoods Association.)
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I agree to having my data stored and shared with East Sooke Together volunteers.
I disagree. Note: You cannot be referred for services.
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Send me a copy of my responses.
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