Back Volunteer Interest Survey Name Address Email * Phone Country (###) ### #### Do you Need Help? (Check boxes) Personal Needs: Periodic Social Visits Morning text, call or personal check-in with a neighbor Set up grocery store delivery Get books to and from library Pet assistance Emergency child care Meal assistance Transportation To/From: Doctor and dentist’s offices or hospital Pick up medicine at pharmacy Shop or pick up groceries Vet for pet visit Home Security and Maintenance: Home Safety-bathroom railings, fall prevention, etc. Indoor/outdoor light bulb replacement Battery replacement for home monitors, smoke detectors, etc. Replace filters for heater/air conditioner Minor maintenance or referral information for appliances, parts/repairs Moving trash/garbage containers to and from curb Hurricane home preparation Yard Needs: Rake leaves or clip bushes Lawn care Water plants Branch removal Education Programs: How to avoid scams Computer and/or cell phone tech support Medication Do’s and Do Instruction on use of Uber/Lyft Other Trash Assistance Mail Pick-up Pool Maintenance Pet Care Child Care Referrals Notary Can You Help? (Check boxes) Personal Needs: Periodic Social Visits Morning text, call or personal check-in with a neighbor Set up grocery store delivery Get books to and from library Pet assistance Emergency child care Meal assistance Transportation To/From: Doctor and dentist’s offices or hospital Pick up medicine at pharmacy Shop or pick up groceries Vet for pet visit Home Security and Maintenance: Home Safety-bathroom railings, fall prevention, etc. Indoor/outdoor light bulb replacement Battery replacement for home monitors, smoke detectors, etc. Replace filters for heater/air conditioner Minor maintenance or referral information for appliances, parts/repairs Moving trash/garbage containers to and from curb Hurricane home preparation Yard Needs: Rake leaves or clip bushes Mow lawn Education Programs: How to avoid scams Computer and/or cell phone tech support Medication Do’s and Do Instruction on use of Uber/Lyft Other Trash Assistance Mail Pick-up Pool Maintenance Pet Care Child Care Referrals Notary Thank you!
