COVID-19 Community Support Request Form
Do you need help?
The Covid-19 pandemic is a challenging time for everyone. We want to help local people to support one another and provide essential services to people who need it.
The purpose of this form is to collect your contact details so we can help connect you to support from a volunteer in your community. We also ask some other questions to find out more about the kind of help you need.
If you need any help completing this form, please contact Wam Get Involved
Some things to remember to keep safe:
* Coronavirus (Covid-19) is contagious. Please avoid physical contact and wash hands regularly.
* If you are self-isolating and someone is delivering essential items to you, please ask them to leave items on the doorstep. Please do not invite people into your home.
* Please inform the person helping you if you have any allergies.
* We suggest that you do not exchange bank details with the person helping you. If you need to pay for something, please only exchange cash.
* You should continue at all times to follow the advice being given by Public Health England.
Do you live alone?
Do you have children under the age of 18 in the household?
Do you have any allergies
Are you receiving support from Social Services
Are you filling in this form for yourself?
By submitting this form, you are agreeing to your details being shared with local community groups, Council services and its health partners, so that we can help support as part of the Coronavirus response. The legal basis for this use is your consent. Your information will not be used for any other purpose and will be removed when the Coronavirus response is complete, or when you withdraw your consent. You can withdraw this consent at any time by contacting the email address given., and Wam Get Involved will remove your data and inform other providers to do so.
What do you need help with?

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