Leander Road Covid-19 Community Support page

COVID-19 COMMUNITY SUPPORT GROUP
PLEASE USE THIS FORM TO REGISTER AS A STREET VOLUNTEER AND TO LET US KNOW WHAT HELP YOU MIGHT NEED.
WHY WE NEED THIS INFO
We need everyone to complete this form, even those are already on the Leander Road Official Facebook group or our Leander COVID-19 WhatsApp group.
Having a bit more detail will help us create a database so we can get properly organised - AND FAST!
Your data will not be shared and will not be used for anything other than community organisation in the immediate COVID-19 crisis.
If you need this form in another language, please let us know. We are creating other language versions as we go. Please also tell us if you have language capabilities to help with translation:
Please send me the link for this language version I can help translate the form into this language
French
Spanish
Portuguese
German
Somali
Arabic
Tigriyna
Your Name*
First NameLast Name
Your street and house number
Which street or road do you live in?
Please give your house or flat number
Your mobile *
We will use this to text or send WhatsApp messages to individuals or groups
Your landline
Area CodePhone Number
Your e-mail*
From time to time we may send emails to individuals or groups
Tell us about your current situation. Tick the one which applies most:
Currently working from home / out and about (can support in the community)Currently in isolation / told to stay at home (can support from behind closed doors)Health, family or other care responsibilities which limit the volunteering support I am able to offerOther

Support is a two way street. How might you need support in the event of self-isolation or illness?

	Yes	No
High risk / vulnerable due to age or pre-existing health conditions	15	16
Live alone	17	18
Have care responsibilities	19	20
Have care needs of my own	21	22
Have children under 5	23	24
Have children of school age	25	26
Require a translator / language assistance	27	28
Have pets	29	30

Do you have other support needs we haven't listed?
Tell us about any other needs you or someone living with you might have, so we can think about ways to help.
Mental Health Support
Self-isolation is going to be hard for everyone. As a community we need to find new ways to communicate and support our mental health during this difficult time.
No one should feel ashamed of asking for mental health support. Rather than wait until people feel depressed or anxious or deep in crisis, we would like to create new community connections and new routines, to give everyone the chance to stay as mentally fit as possible.
If you have existing anxiety or mental health issues, please also check in with your health provider to make sure your treatment plan is updated for this new situation.

Tell us if you would be interested in any of these mental health support options if we can put them in place:

	Yes	No	Maybe
Someone from the street calling me on my mobile to check in and chat	31	32	33
Having a street buddy I can call if my anxiety rises	34	35	36
Being able to join in group relaxation events such as online yoga, online meditation etc.	37	38	39
Being able to join in group social events such as online morning check ins, tea parties, film club, pub quiz etc.	40	41	42
A managed news thread so I don't have to read all the disaster reports, but get essential safety information	43	44	45
A go-to list of numbers, tutorials and mental health support info that I can turn to in times of stress	46	47	48

Are there any other mental health support requirements we haven't listed:
Tell us about anything else you might need or could offer.

What voluntary support can you offer our community?

	Yes	No	Maybe
Running local errands for neighbours (eg post, shopping, chemist)	49	50	51
Errands in your car (eg click & collect shopping, making deliveries)	52	53	54
Befriending & isolation support (eg checking in with neighbours, arranging chats via phone or Skype)	55	56	57
Counselling / mental health support chats via Skype or phone (if qualified)	58	59	60
Online fitness or wellness support (eg organising virtual relaxation, yoga or keep fit groups) for those in isolation	61	62	63
Organising an online community activity (book club, film club, pub quiz) for those in isolation	64	65	66
Respite cover for parents (eg child care, babysitting, or virtual tutoring)	67	68	69
Respite cover for carers of elders or disabled residents (eg sitting / minding, cooking)	70	71	72
Medical support (if qualified)	73	74	75
Food collection and redistributions (sharing scarce resources)	76	77	78
Pet care / dog walking	79	80	81
Distribution to neighbours (eg posters, leaflets)	82	83	84
Admin or back office support for the community team	85	86	87

Are there any volunteering roles or ideas we haven't listed?
Tell us about anything else you could offer.

Do you have any special talents or occupational skills we can call on?

	Yes	No
Medical training	88	89
Good at admin	90	91
Good at research	92	93
Wizard at IT	94	95
Good at supplies and logistics	96	97
Qualified to teach stuff	98	99
Speak more than one language	100	101
A bit of a musical genius	102	103
Trained in keep fit, yoga etc	104	105
DBS cleared for care and childcare	106	107

Do you have any other skills, or general comments, ideas or suggestions?
This is your community. Your ideas and input matter!
YOUR COMMUNITY ADMINS
This community database is being administrated on a voluntary basis by Pippa (07764941154) and Judy (07788696029). We may add other administrators as need arises.
DATA PROTECTION
Your contact information will not be shared except for purposes of organising our community during this crisis.
WHAT HAPPENS NEXT
If you have offered to help: we will respond shortly, to put you in touch with neighbours who need support or want to work with you to set up community activities.
We will send direct messages (email, text or WhatsApp) but also keep an eye out on the street facebook page and the WhatsApp thread.
If you have asked for support: We will be in touch to signpost you to neighbours who have offered the sort of support you requested.
We will send direct messages (email, text or WhatsApp) but also keep an eye out on the street facebook page and the WhatsApp thread.
AND FINALLY ....
We ask that everyone remembers we are a street of friends and willing volunteers. No money is changing hands. We all give our time and energy freely because we want to make the world a better place during an unprecedented, alarming and immensely difficult time.
If you do not like something or wish to opt out, just let us know, and please remember to be kind!
Should be Empty:

	Please send me the link for this language version	I can help translate the form into this language
French
Spanish
Portuguese
German
Somali
Arabic
Tigriyna

COVID-19 COMMUNITY SUPPORT GROUP