Mask Bloc Denver Request Form

Mask Bloc Denver Request Form

If you need to contact us for any reason, please email maskden@proton.me
We provide masks and supplies for protection from airborne viruses and wildfire smoke to individuals and organizations in the Denver Metro area.

We are a very small volunteer group and will work to fulfill requests within 2 weeks.

We check requests on Sundays & Thursdays.
**Your personal information will be deleted after your request has been fulfilled.**
Would you rather be contacted via email or signal?

emailsignal
Email
example@example.com
Can we add you to our email list? (only your email would be stored in CryptPad)

YesNo
Signal Username
What should we call you?
Pronouns
Your location*
Organization name (if applicable)
What do you need?*

MasksTestsCR Box Loan
Our inventory is inconsistent so we cannot guarantee a certain number of masks or styles. However, for personal requests, it is generally reasonable to ask for 10-15 masks per person. For organizations, 50-75 is pretty reasonable with less room for selection of specific styles.

We may go above this when we are able to, but of course can't make any guarantee!

Masks can be resused! You should dispose of your mask once there is visible damage, the mask no longer fits your face well (headstrap stretched out, damage to the nosewire, etc), or if it becomes difficult to breathe through.
Number of masks requested*
What mask size(s) do you need?*

Extra Small (Kids)Small (Kids)Regular (Kids)SmallRegularLarge
What type of mask(s) do you prefer?*

EarloopsHeadstrapsTrifold StyleBifold StyleCup StyleDuckbill StyleNo preference
Is this for an event?*

YesNo
We love to table and/or consult to help events be covid-safer, would you be interested in this? (depending on availability)

Interested in MBD tabling to provide masks, info, etcInterested in MBD consulting on making this event as safe as possibleNo thank you
Mask request notes
Number of boxes of tests*
Current test inventory expires June 2026, 2 tests per box
CR Box Loans

We highly recommend that CR boxes are used alongside masking to best protect from airborne virus spread.
Best practice acknowledgement*

I understand that CR boxes are not a substitute for masking
Requested loan start date*

MonthDayYear
The standard loan period for a CR Box is one week.

If you need a CR Box for longer than a week, please specify in the loan details box below.
Loan details
Urgency of request*

ASAP (trying for within 48 hours)2 weeks (standard turnaround)No rush (low priority)
How would you like to receive your requested items?*

Meet volunteer somewhereDeliveryEither
Location preferences
A good spot for you to meet up, furthest distance you're willing to go to meet a volunteer, etc
Address for drop-off

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What days of the week work best for drop-off or pickup?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Best time of day for drop-off or pickup?*

M-F, MorningM-F, AfternoonM-F, EveningSaturday/Sunday, MorningSaturday/Sunday, AfternoonSaturday/Sunday, Evening
Is someone in your household currently sick with a contagious illness?*

YesNo
Is there anything else you'd like us to know?
(Questions, comments, security needs, etc.)
Should be Empty:

Mask Bloc Denver Request Form

**Your personal information will be deleted after your request has been fulfilled.**

CR Box Loans

Your personal information will be deleted after your request has been fulfilled.