COVID-19 help form | Lifewaycc

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SELF ISOLATING

DUE TO COVID-19

ASSISTANCE FORM

For Lara (and district) residents only

We'd like to help if we can, fill out the form below and someone will get back to you as soon as possible.

Personal details

I would like help with the following task (s)

Can someone please call me for a friendly chat

Can someone please run an errand for me

Can someone collect shopping that I have ordered and paid for

Can someone please collect mail from the post office

Can someone please take my dog for a walk

I am in need of urgent supplies (please give us more information in the box below)

I would like someone to pray for me (please type out your prayer request in the box below)

Other - fill out your request in the box below

I am self-isolating because:

I have the COVID-19 virus

I have recently travelled overseas

I have been in close contact with a confirmed case of COVID-19

I am over 70 years of age

I am unwell

I am concerend for the health and well being of myself and my family

Other (please explain below)

Once your form has been received and your request assessed, someone will notify you and talk you through the next steps.

If this is an emergency please call 000

© 2018 Lifeway Christian Church Lara.