Gavinton Fogo & Polwarth Community Council

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Gavinton, Fogo & Polwarth Resilient Communities Plan

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Do You Need Support?

We recognise that in times of severe weather or utility failure, some people in our community may need a bit of extra support from the resilient community volunteers, so we’d like to build a list of people who may need some assistance in severe weather or during a power cut (e.g. if you have a disability, or need to look after young children so can’t clear your drive). If you would like to be included in this list please speak to one of the scheme co-ordinators or complete this form.

Do you require additional support and assistance in an emergency?

If so, please complete this short form.

This information will only be used by the Resilient Community coordinators to contact you for more information.

First names:            

Surname:                

Please provide a valid email address or the site's anti-spam measures will prevent the form being sent.

Email Address:         

Please provide your preferred telephone number so we can call you to discuss the support you require.
(If you prefer not to provide a number initial contact will be made via email.)


Telephone No.:                  

If you wish, you can use this box to tell us about the support you need but someone will be in touch very soon to talk about your requirements so don't worry if you prefer to leave this blank.

                            

In order to prevent spammers misusing this form, we use the 'reCaptcha' system. Please type in the characters you see in the image below. This confirms that you are not a robot.
If the image is hard to read click the 'reload' button next to the entry box for a new text.

Press the submit button, once, to send the form. Remember, your form will not be sent unless you have provided a valid email address.