KINGSWOOD COMMUNITY SHOP: COVID-19 CONSULTATION

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* 1. What types of support may be beneficial to you? (tick as many as apply)

To connect with your local community e.g. through online social chats

Providing information about current support available such as shopping/prescription deliveries/local authority provision/accessing funds

Helping with completion of online forms/information searches

Having a regular 'phone call to check if there is anything you need

Any other support needed (please describe)

Other (please specify)

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* 2. Please state your full name

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* 3. Please state your mobile telephone number (if you have one)

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* 4. Please state your landline telephone number (if you have one)

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* 5. Please state your email address (if you have one)

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* 6. Please state your full postcode

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* 7. Please let us know how you prefer to be contacted (choosing both options, where possible, will help us to reach you more efficiently.

Mobile 'phone number

Landline 'phone number

The information provided will be used by the Kingswood Community Shop, ensuring you receive the specific support you have requested. All information will be stored securely, accessible only to staff, trustees and volunteer supporters. By completing this form and pressing 'send' you agree to the Kingswood Community Shop using the information you have provided in line with our data protection/confidentiality policies (available on request).
Data Protection Statement
In keeping with the Data Protection Act 1998 we will hold this information securely and confidentially and will not pass it to any other agencies without your consent. We will only use the information for monitoring purposes and to inform you about your chosen support.
Thank you for completing this short questionnaire - we will aim to respond to your request as soon as possible - we look forward to connecting with you!