Recipient Sign-up
Name
*
First Name
Last Name
Name of person filling this form out
*
Self
What type of "Buddy" would you like (check all that apply):
Phone Buddy - phone chats, check-ins, and online ordering support
Tech Buddy - provide phone tech support for Zoom, basic smart phone questions, online orders, etc
Meals/Grocery Buddy
Transportation Buddy
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Year of birth
*
Is there anything about yourself that will be helpful to know as we match you with a buddy?
Submit
Should be Empty: