Online Form - I Can Help

There are many elderly and vulnerable people in our community facing unprecedented challenges and increasing isolation due to COVID0-19.

Through the COVID Heart Initiative, we can all look out for each other and show a little kindness.

Please complete your details below and we'll be in contact shortly to match you with someone needing assistance.

This initiative is a partnership between the Shire of Dandaragan, Jurien Bay Community Resource Centre and Dandaragan Community Resource Centre.

What tasks are you able to assist with (tick all that apply)

*Other tasks (specify here)

First Name*

Surname*

Phone Number*

Email*

Street number and name

Street Address:

City:

State:

Post Code:

Country:

Type the code from the image:

The code you entered is not valid.

Type the code from the image