covid-19 assistance

Name *

First Name

Last Name

Phone *

(###)

###

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How can we help? *

Check all that apply.

I need prayer

I need financial assistance

I need help getting groceries

I need to talk to someone/I need community

Other

Name *

First Name

Last Name

Phone *

(###)

###

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I can help in the following ways: *

Check all that apply.

I can pray for someone/with someone over the phone

I can purchase groceries for someone

I can pick up & deliver groceries for someone

I can give someone a call and check in

Other