Give Help - COVID-19 Volunteers

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* 1. Disclaimer: I consent that information collected in the survey by United Way Centraide North East Ontario may be shared with partnering charities to fill available volunteer opportunities.

I consent to the disclaimer

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* 2. Contact Information

Name

Organization

Address

Address 2

City/Town

Province

Postal Code

Country

Email Address

Phone Number

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* 3. Have you volunteered in the last three years?

Yes

If you have volunteered, please indicate the name/s of the organization and contact person/s.

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* 4. Do you have any of the following health symptoms

Fever

Cough

Difficulty Breathing

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* 5. Are you bondable?

Yes

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* 6. As a volunteer, what is your area of interest?

Grocery Shopping, Pick-Up and/or Delivery

Digital Literacy Assistance

Social Support, Telephone Outreach

I want to make and donate fabric masks

Other (please specify)

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* 7. Do you have a valid drivers license?

Yes

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* 8. Do you have access to a personal insured vehicle?

Yes

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* 9. Do you have access to a desktop computer?

Yes

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* 10. Do you have access to the Internet?

Yes

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* 11. AVAILABILITY - What days of the week are you available

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Other (please specify)

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* 12. What are your hour preferences

Mornings (AM)

Afternoon (PM)

Other (please specify)

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* 13. Any additional Information you would like to share - Please enter here

Thank you for your interest in showing your Local Love during this Global Crisis. We will be in contact very soon.