ChristChurch COVID-19: Needs & Response Survey

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If you need help or are able to help the community in this health crisis, please fill out this survey to tell us what your needs are or how you can help respond to the needs in our larger community.

Please check all that apply. If you have questions email Admin@comchristchurch.org

Name *

Email *

Phone Number *

I or someone I know needs help with:

Getting groceries or other essentials

Picking up and delivering drug prescriptions

Receiving face masks

Connecting online, getting setup with Zoom, etc.

Transportation to medical appointments

Other:

I would appreciate a phone call to further discuss my needs or needs of people I know.

Yes

I can help with.....

Shopping for groceries

Delivering groceries ordered on line

Picking and delivering drug prescriptions

Sewing face masks

Technical assistance to help people stay connected online

Transportation to medical appointments

Other:

Submit

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