Mask Up Baltimore - Mask Request Form

Mask Up Baltimore - Mask Request Form
Fill out this form to receive FREE masks and FREE rapid covid tests from Mask Up Baltimore! We are a group of neighbors providing contactless, drop-off deliveries to all zip codes within Baltimore City.

At this time we are unable to fulfill requests from outside Baltimore City.

Once your request is submitted, deliveries may take 1-2 weeks to fulfill depending on the capacity/availability of volunteers.
This form is for individuals and households.
If you are organizing an event or are interested in handing out a larger quantity of masks and/or tests (more than 25), please email us at maskupbalt@protonmail.com.

If you need to cancel your request, or have additional questions, please email us at maskupbalt@protonmail.com.

Please note that if after contacting you twice within two weeks and if we do not hear back from you, we will cancel your request.
Thank you for masking up!
First Name*
First name, nickname, or alias. Last name not required!
Pronouns
Email
example@example.com
Phone Number
Please enter a valid phone number.
Preferred Contact Method. Please note,*

EmailPhone CallText Message
When do you need your masks and/or tests by? *We will try our best to meet urgent requests, but it will depend on volunteer availability.*

MonthDayYear
Date
Do you need masks, tests, or both?*
Please select the style of masks you want (can select multiple). *If we do not have the mask you select, we will do our best to provide a similar alternative.*

Headstrap N95 (Trifold)Headstrap N95 (Duckbill)Headstrap N95 (Cup style)Ear Loop KF94 (Trifold Adult-Large)Ear Loop KF94 (Trifold) - ChildEar Loop KF94 (Trifold) - ToddlerEar Loop KN95 (Bifold) - ChildEar Loop KN95 (Bifold) - ToddlerOther
How many masks do you want? If you selected multiple kinds, please specify how many of each kind. *If you are looking for a quantity of more than 25 per household, please email us at maskupbalt@protonmail.com*
Would you like a mask trial kit? We will give you 1-2 masks of each kind we have available so you can try them and find the mask that works best for you.

YesNo
How many tests do you want?*
What neighborhood do you live in? We will reach out for address/location specifics.*
What days of the week work best for delivery?*

SundayMondayTuesdayWednesdayThursdayFridaySaturday
How did you hear about us?

Word of MouthPostersInstagramOther
Is this your first time requesting masks from Mask Up Baltimore?

YesNo
Please list any additional questions, comments or concerns.
Would you like to volunteer with Mask Up Baltimore?

YesNoMaybe
Would you like us to print any of these zines to add into your Mask Up Baltimore drop off? (More Zines to come~ Permissions and compensating the creators takes time!)

How To DIY a Good Mask Seal by AlekzHow To Take a RAT (Rapid Antigen Test) By COVID Conscious Bloc of San AntonioThe Swiss Cheese Model for Layered COVID-19 Protection by Stevie Springs 2024 (Digital Copy Only)Masking Through Blackness by Sabrina Sims (need to purchase b4 publishing this section) (Digital Copy Only)Mask Up We Need You by Sheyam Ghieth and Rimona Eskayo 2024 (Digital Copy Only)
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