COVID-19 Help Request Form
If you have been diagnosed with coronavirus, asked to self-quarantine, or are part of a vulnerable group where social distancing has been recommended, we want to support you in this time of need. Please fill out this form and we will contact you, and do our best to help you as we're able.
Email address *
Name *
Phone number *
Address *
If you're interested in a care package and live in the Georgina area, please provide your full address and any special instructions about doors/apartment number/etc. If you do not want a care package, please only provide your town name.
Is Maple Hill your home church? *
You do not have to be a member of Maple Hill or a Christian to receive help from the church and your answer to this question will not determine the help given to you.
How can we help you? *
Please indicate if you are interested in receiving a care package or if you need help with an essential errand, etc.
Do you have a prayer request as well? (Optional)
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy