CARE Support Request Form

CARE Support Request Form

You will only be able to request help for a maximum of three times before you will need to have a referral from one of our partners if you will be requesting a food parcel and/or prescription pickup service. Pastoral Care is always available with no limit on the amount of times it can be requested. Once you have a referral, you will be able to receive help from us over a 90 day period. We hope that 90 days worth of help will be enough for your circumstances to improve. If your circumstances have not improved after this time, we will be happy to help you again… all you need to do is get another referral. To find out more about who our referral partners are and how to get a referral, please click here.

This number must match our records exactly, otherwise we will be unable to help you.

Temporary Assistance Request

Your Details

Please ensure that these details are filled in accurately. Thank you.

The CARE Project is here to help anyone who is in genuine need. This means that if you have help available to you in the form of family/friends to get food/prescriptions/click and collect deliveries, or you have the financial means to buy your own food, we are not able to help you.

Your Request

Your food parcel will be made up of food donated by businesses, supermarkets and other charitable enterprises. Some food contained in your parcel may be beyond it’s “Best Before” date, and some food may be frozen prior to its “Use By” date. Food that is past its “Best Before” date is still edible. We will endeavour to ensure that food allergens are labelled where appropriate, but we cannot guarantee that there has been no cross-contamination during the decanting, sorting and preparing of foods. By continuing with this request, you are agreeing that you understand this, and that any food you accept from us becomes your responsibility on transfer.

Please let us know if anyone in your household has any dietary requirements, or whether there are any particular items you desperately need or don’t need Please remember: food is donated to us, so we cannot guarantee stock of any particular item. Also, delivery drivers will not take unwanted food back with them once it has been delivered to you.

e.g Toothpaste, Soap, Toilet Roll, Sanitary products. We DO NOT supply clothes or pet food. Please remember that we CANNOT guarantee that these items will be available when we compile your food parcel.

Once you submit this form, a volunteer will get in touch with you to organise a mutually convenient time to collect the “Click & Collect” food shop and deliver it to you.

Your Request: A Telephone Call

We want to allocate a volunteer that is suited to your needs. If you need to talk about something specific, please let us know in this box. It may also be helpful to know a little bit about you, your age, and your interests. This may mean that we are able to connect you with other people in the community. However, please don’t feel you need to fill this box in!

Is there anything in particular you would like to discuss with Rev. Dean? Please don’t feel you have to fill in this information at this time. Once you submit the form, he will be in touch with you as soon as possible.

Your Request: Prescription Collection

We are working with local pharmacies to deliver prescriptions to people in our area. In agreement with local pharmacists, we have a set procedure for delivery:

Your prescription will be delivered the NEXT WORKING DAY once you have submitted your request provided you submit it within our opening hours (Monday-Friday, 9am-3pm).

Please do not submit your request if your prescription is not ready for collection.

By submitting this request form, you are agreeing that we may hold your information in accordance with our Privacy Policy, and that we may use it to provide a service to you. Once your request is submitted, we will endeavour to action it as soon as reasonably possible. A volunteer will be in touch via telephone and/or email to confirm your details. If you do not hear from us 48 hours (Monday-Friday), please telephone The Support Line on 02921 880 212, option 0. Following completion of your request, a volunteer may be in touch to follow up and check that everything went OK.

Referred Assistance Request

Service User Details

Please ensure that these details match your referral details exactly. You CANNOT put in a request for someone else.

This address must match the address on your referral record.

The CARE Project is here to help anyone who is in genuine need. This means that if you have help available to you in the form of family/friends to get food/prescriptions/click and collect deliveries, or you have the financial means to buy your own food, we are not able to help you.

Your Request: Essentials Food Parcel

Your food parcel will be made up of food donated by individuals, businesses, supermarkets and other charitable enterprises. Some food contained in your parcel may be beyond it’s “Best Before” date, and some food may be frozen prior to its “Use By” date. Food that is past its “Best Before” date is still edible. We will endeavour to ensure that food allergens are labelled where appropriate, but we cannot guarantee that there has been no cross-contamination during the decanting, sorting and preparing of foods. By continuing with this request, you are agreeing that you understand this, and that any food you accept from us becomes your responsibility on transfer.

Please let us know if anyone in your household has any dietary requirements, or whether there are any particular items you desperately need or don’t need Please remember: food is donated to us, so we cannot guarantee stock of any particular item. Also, delivery drivers will not take unwanted food back with them once it has been delivered to you.

e.g Toothpaste, Soap, Toilet Roll, Sanitary products. We DO NOT supply clothes or pet food. Please remember that we CANNOT guarantee that these items will be available when we compile your food parcel.

Your Request: Click & Collect

Once you submit this form, a volunteer will get in touch with you to organise a mutually convenient time to collect the “Click & Collect” food shop and deliver it to you.

Your Request: A Telephone Call

We want to allocate a volunteer that is suited to your needs. If you need to talk about something specific, please let us know in this box. It may also be helpful to know a little bit about you, your age, and your interests. This may mean that we are able to connect you with other people in the community. However, please don’t feel you need to fill this box in!

Your Request: Speak to the Vicar

Is there anything in particular you would like to discuss with Rev. Dean? Please don’t feel you have to fill in this information at this time. Once you submit the form, he will be in touch with you as soon as possible.

Your Request: Prescription Collection

We are working with local pharmacies to deliver prescriptions to people in our area. In agreement with local pharmacists, we have a set procedure for delivery:

Your prescription will be delivered the NEXT WORKING DAY once you have submitted your request provided you submit it within our opening hours (Monday-Friday, 9am-3pm).

Please do not submit your request if your prescription is not ready for collection.

By submitting this request form, you are agreeing that we may hold your information in accordance with our Privacy Policy, and that we may use it to provide a service to you. Once your request is submitted, we will endeavour to action it as soon as reasonably possible. A volunteer will be in touch via telephone and/or email to confirm your details. If you do not hear from us 48 hours (Monday-Friday), please telephone The Support Line on 02921 880 212, option 0. Following completion of your request, a volunteer may be in touch to follow up and check that everything went OK.

Referral Form

As a referral partner, you are able to refer an individual/family to us for assistance. This assistance will last 90 days, at which point we hope that the individual or family concerned will have found a permanent solution to their crisis. If this is not the case, you may refer them again after meeting them to discuss their ongoing needs and assessing them.

Referrer Details

Please ensure that these details are filled in accurately. Thank you.

This will be the name of the organisation you work for.

Eligibility

This section helps us to understand the Service User’s needs.

We cover the following post codes: CF83, CF3 6, NP10 8. If the service user does not fall into any of these postcodes, we are unable to help due to limitations on funding and volunteer numbers.

Please detail in this box any additional information you feel would help us understand the Service User’s situation, and what their particular needs are. If there are no additional details, please type N/A

Service User Details

Please ensure that these details are filled in accurately. Thank you.

If the Service User does not have an email address, please use your email address.

By submitting this request form, you are declaring that you have told the Service User how our system works, and that they agree to us holding their information in accordance with our Privacy Policy, and that we may use it to provide a service to them. You are also agreeing that we can hold the information you have submitted about yourself on our files. Once your request is submitted, you will receive an email with a referral number which you must keep for your own records.