SHARE - Shop and Help: A Rewarding Experience - Form

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SHARE - Shop and Help: A Rewarding Experience

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First Name

Last Name

Phone # (cell phone preferred)

Address

What is your comfort level with technology?

I am tech savvy and have all the devices I need for functioning at home and staying connected. Contact me whichever way is easiest.I am good with emails, but struggle to read and respond to text messages and video calls.Please call me. I struggle with email and text

I am currently

Please Choose OneHealthy, in a low risk category and would like to help others who need assistanceIn a high risk category and could use some assistance with errandsDoing well for now but may need help down the road

I am available to (check all that apply):

Make phone calls to check in on peopleDo shopping and other errands for those who should not be going outI can help with pickups and deliveries, but I cannot do shopping.

Let us know when you are available to help, please check all that apply.

Sunday MorningsSunday Afternoons or EveningsMonday MorningsMonday Afternoons or EveningsTuesday MorningsTuesday Afternoon or EveningsWednesday MorningsWednesday Afternoons or AfternoonsThursday MorningsThursday Afternoons or EveningsFriday MorningsFriday Afternoons

I would appreciate (check all that apply)

Shopping AssistanceA phone or video visit.

What other assistance would be helpful?

Wed, May 1 2024 23 Nisan 5784

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