COVID-19 Register for help
Please complete this form if you could benefit from support or know someone that would.
I consent to sharing my data with groups and individuals committed to supporting a Slough response to Coronavirus. We will not share your data with anyone that would sue your data for profit.
I am filling in this form on behalf of someone else and they have provided me with consent
Please provide at least one means of contact
Name of person requiring support
Phone number of person requiring support
Email of person needing support
Email of person filling in this form if different from above
Address of person requiring support including postcode
Is this person...
A carer or cared for
Dealing with a severe chronic health condition
Non perishable goods e.g. tinned food, cleaning products, toilet roll.
Medicines or prescriptions picking up
Daily welfare call
Unknown (we can call to find out precise needs)
Health welfare checks - regular catch up
Name of person completing form (if different from above)
Telephone number of person completing form (if different from above)
If you are human, leave this field blank.
Username or Email Address
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