TELESOCIAL FORM

During this time of self-quarantine, it is very easy for social distancing to become social isolation…especially for seniors, who are most at risk for COVID19 so must stay away from other people. If you, or someone you love, would like to receive a friendly phone call from a volunteer to check-in, share your experiences in self-quarantine, and just chat, sign up for L.A. Works TeleSocial program. Because we are #StrongerAsOne!

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Please enter phone numbers like this (XXX)XXX-XXXX

Please enter your full date of birth using only numbers. EX: 06/01/1954

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By clicking this box, I confirm that the person being signed up to receive these calls is 18 years of age or older.
I understand by submitting this form I am asking, for myself or a call recipient I am assisting, to receive phone calls from an L.A. Works TeleSocial Volunteer. I understand that "TeleSocial" means that these calls are strictly social, conversational calls, wherein the dialogue is intentionally steered toward common interests and no medical, financial, or other advice on other services will be given by the volunteer. These should be fun and friendly calls, enjoyed by both parties. I understand that the caller will only receive the first name of the call recipient and phone number and that any further personal information shared in my phone conversation is considered confidential. I understand that the role of the call recipient is to simply receive social calls from the volunteer caller. The call recipient will know not to breach the boundaries of this program by asking for advice. I understand that any further questions about the program can be answered by an L.A. Works Staff member.