Please fill out this application if your home on Grand Bahama was damaged by Hurricane Dorian and you are in need of services. Your
information will be matched with local and international non-profit organizations who are providing mucking/gutting services, mold
remediation, rebuilding, and vouchers for appliances and furniture. Completing this form does not guarantee services or goods.
I hereby authorize The Grand Bahama Disaster Relief Foundation to share any of my information in its possession,
including but not limited to my name, address, other personal information with other disaster relief and
voluntary organizations in partnership with this system in order to coordinate potential disaster relief
services and assistance. I understand that my information will be shared with participating members of the
GB Home Repair working group in order to direct community resources.
I understand that I may revoke this consent at any time by contacting
The Grand Bahama Disaster Relief Foundation except when action has already
been taken to obtain and/or release such information to member organizations of
GB Home Repair working group.
My acceptance on this release indicates that I have read the above,
and that I understand the terms and conditions.
I am also accepting this release on behalf of my children that are under the age of eighteen (18).
Completing this form does not guarantee services or goods.