Community Support Registration

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Neighbors Helping Neighbors


Please correct the field(s) marked in red below:

Franklin is all about community. If you are a resident of the City of Franklin, we would like to make sure our seniors and those who need some extra assistance are able to stay connected during Ohio's Stay-At-Home order issued by state officials.

 

By filling out this form, we will reach out to you or your loved one to offer some personal connections.  If there are special needs, we will work with local volunteers and agencies to support those who have limited capabilities.  Please understand, safety is our number one priority therefore our primary mode of communication will be by telephone.


1
Please provide your (or loved one's) contact information.
 *
Please provide your (or loved one's) contact information.
2
How often would you like us to check in on you, or your loved one?
3
Which day(s) would you like us to make contact?
 *
Which day(s) would you like us to make contact?
Your neighbors have volunteered to help check on their neighbors.  If a need exists beyond our capabilities to assist, we need to know who to contact to assist us.  Please provide the following information so we know who to turn to.
4
Emergency Contact Information: Who would we contact if a need exceeds the capabilities of our volunteers?
 *
Emergency Contact Information: Who would we contact if a need exceeds the capabilities of our volunteers?
5
Who is this person to you?
  1. To receive a copy of your submission, please fill out your email address below and submit.