Building a Community Response to Coronavirus Disease (COVID-19)

1
The goal of Gauteng Together is to mobilise Community Activity Networks (CANs) across Gauteng to assist those in need during this difficult time. Each CAN will be organised at neighbourhood level and joined to the Gauteng Together network. Gauteng Together will provide detailed guidelines for how to set up a CAN, as well as assist, collaborate, brainstorm and share knowledge.
2
Please verify that you are human* This field is required.
3
Terms and Conditions* This field is required.By accepting these terms and conditions, you are consenting to the use of your contact details as per the conditions set out below. You also indicate that your contact details will NOT be given to any 3rd parties, but may be shared with other registered CANs within the Gauteng Together network, for the purposes of shared interests, assistance, and helpful communications. By clicking “accept” you agree that you are aware of the following conditions: 1. If provided with any other member’s details of a CAN, you will not use those details for any other purpose than shared interests, assistance, and helpful communications, to meet the ends of the Gauteng Together collective. 2. Your personal info will be protected and NOT used in any manner without your consent, according to POPI (the Protection of Personal Information Act). 3. If you provide your information it will only be used within the manner under which it was consented. 4. Your information will ONLY be provided to registered CAN coordinators for Gauteng Together. Those registered CAN coordinators will be required to use your information in such a way to protect your information and not to pass it onto 3rd parties without your consent. 5. You may complain about any failure to comply with the above, you may lodge a complaint with complaints@gautengtogether.org. Alternatively, you may lodge a complaint with the POPI REGULATOR using the form prescribed.
4
Name* This field is required.
First Name
Last Name
5
Cell Number* This field is required.
6
Email* This field is required.
example@example.com
Confirm Email
7
Address* This field is required.
Street Address
Suburb
City
Province
Postal Code
South Africa
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
What skills do you have to share?Please scroll down for more options.
Administration
Buying
Care giver (elderly)
Carpentry
Catering
Communication
Construction
Cooking
Coordination & logistics
Counselling
Data management
Electrician
Finance
Fund raising
Grow food
Handy person
Health care
Home visits
Legal
Pet care
Plumbing
Research
Sewing
Surveys
Teaching
Technical - support
Technical - web development
Training
Transportation
Writing
Other
9
What resources do you have to share?Please scroll down for more options.
Cash donations
Prepared food
Fruit and vegetables
Groceries
Meat or chicken
Kitchen
Disposable gloves
Masks (cloth)
Soap
Hand sanitisers
Medical equipment
Medication
Personal protective equipment (PPE)
Spare room for isolation
Time
Transport
Other
10
Would you be interested in leading your own CAN in your neighbourhood?* This field is required.If you want to lead a CAN, select YES. If you want to volunteer to join an existing CAN, select NO.
YESNO
11
Why would you like to be involved in starting and/or leading a CAN?* This field is required.
12
Are you involved in another organisation that provides related or relevant support?* This field is required.This might include an NGO, community organisation etc.
YESNO
13
Details of the organisation * This field is required.
Name of the organisation
Your role/position in the organisation
Goal and or objective of the organisation
Website or Facebook page of the organisation
14
Would you like to be added to the mailing list to be kept up to date of events and projects?* This field is required.
YESNO
15
Any other comments or feedback?
Should be Empty: