I need help

Name:*

Surname:*

E-Mail:

Phone:*

Street:* Number*

Zip-Code:*

Job:

Other Job:

District:

This job should be done in the following period:
From:

To:

I am totally healthy and do not have symtpoms which indicate having an infection of Covid-19
I hereby confirm that I have read the helper instructions.
I hereby confirm that I have read and agree to the privacy policy of this page. The data cannot be viewed publicly and is only used to mediate contacts for help-seekers.