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Adopt A Neighbor Request Form - COVID-19 Response

Get Help from a Neighbor Volunteer - COVID-19 Response

Fill out this form to request help from a neighbor volunteer through this uniquely challenging time. Responses are confidential. We are looking for neighbors in Fort Collins and the surrounding Growth Management Area who are vulnerable to COVID-19 and need assistance with daily tasks.  You will be paired with a volunteer in your community!  Tasks may include but are not limited to grocery shopping and delivery, basic errands, driveway shoveling, pet care and more. You will:  

  • Be connected with a neighbor who wants to help and is background checked and trained by the City of Fort Collins on COVID-19 Safety.  

  • Develop a list of tasks that would help you be more comfortable to be completed by the volunteer neighbor. 

  • Assign volunteer neighbor errands or tasks to help you. 

We will attempt to accommodate this request if possible but cannot guarantee it.

If this message reaches anyone who would like to volunteer to help, please fill out this application to be paired with a neighbor in need https://engage.fcgov.com/d/HR/App/AdoptANeighbor
 

9. How do you prefer to be contacted by a volunteer neighbor?
10. What kind of tasks would you like help with? 
11. How often would you like someone to check in with you:
12. What length of time do you anticipate needing help from a neighbor?

RESIDENT CONSENT, RELEASE OF LIABILITY, COVENANT NOT TO SUE, AND HOLD HARMLESS

I hereby request placement as a recipient in the Adopt-A-Neighbor Program ("Program"). I understand that volunteers will not be allowed to enter my home.

I hereby release the City of Fort Collins, its officers, employees, volunteers, and agents (collectively, "Releasees") from any and all liability for any and all claims and causes of action which I may hereafter have on account of any and all injuries and damage to me or my property, or loss of any other sort, arising out of or relating to my participation as a recipient in the Program and the services provided to me, or incidental thereto, whether caused by the negligence of the Releasees or any other person. In addition, I covenant and agree not to sue any of the Releasees, and agree to forever hold them and each of them harmless from any liability, claims, demands, actions, or causes of action whatsoever arising from my participation as a recipient in the Program and the services provided to me, whether such liability, claims, demands, or actions are the result of the negligence of the Releasees or any other person. This release of liability, covenant not to sue, hold harmless agreement shall be binding upon me and my heirs, executors, administrators, personal representatives, and assigns, and shall inure to the benefit of the Releasees and their successors and assigns.

14. I agree to the guidelines above and wish to participate in the Adopt A Neighbor program. *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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