We have exhausted our relief funds. Please complete the form below to be added to our waitlist.
Grace Bible Maui Fire Relief Application
Grace Bible Church is happy to be able to provide funds to families that were affected by the Maui Fires. We do need the following information to process your request.
Have you received Maui Fire Relief funds from Grace Bible Church Maui before? (This will not affect your ability to receive more funds)
*
Yes
No
How did you hear about this relief fund?
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Did you own or rent your house in Lahaina?
*
Own
Rent
Lahaina Family Main Contact #1 Full Name
*
First Name
Last Name
Lahaina Family Main Contact Email
*
example@example.com
Lahaina Family Main Contact Phone Number
*
Please enter a valid phone number.
Lahaina Family Main Contact Phone Carrier
*
Number of adults in household.
*
Number of children in household.
*
Grace Bible Church Maui Contact
*
First Name
Last Name
Grace Bible Church Maui Contact Phone Number
*
Please enter a valid phone number.
Other People in Household
Please list all other people previously living in your Lahaina home.
Full Name #2
*
First Name
Last Name
Person #2
*
Child
Adult
Child #2 Age
Email #2
example@example.com
Phone Number #2
Please enter a valid phone number.
Phone Carrier #2
Full Name #3
First Name
Last Name
Person #3
Child
Adult
Child #3 Age
Email #3
example@example.com
Phone Number #3
Please enter a valid phone number.
Phone Carrier #3
Full Name #4
First Name
Last Name
Person #4
Child
Adult
Child #4 Age
Email #4
example@example.com
Phone Number #4
Please enter a valid phone number.
Phone Carrier #4
Full Name #5
First Name
Last Name
Person #5
Child
Adult
Child #5 Age
Email #5
example@example.com
Phone Number #5
Please enter a valid phone number.
Phone Carrier #5
Do you need to add more people?
*
Yes
No
Full Name #6
First Name
Last Name
Person #6
Child
Adult
Child #6 Age
Full Name #7
First Name
Last Name
Person #7
Child
Adult
Child #7 Age
Full Name #8
First Name
Last Name
Person #8
Child
Adult
Child #8 Age
Full Name #9
First Name
Last Name
Person #9
Child
Adult
Child #9 Age
Full Name #10
First Name
Last Name
Person #10
Child
Adult
Child #10 Age
Do you need to add more people?
*
Yes
No
Full Name #11
First Name
Last Name
Person #11
Child
Adult
Child #11 Age
Full Name #12
First Name
Last Name
Person #12
Child
Adult
Child #12 Age
Full Name #13
First Name
Last Name
Person #13
Child
Adult
Child #13 Age
Full Name #14
First Name
Last Name
Person #14
Child
Adult
Child #14 Age
Full Name #15
First Name
Last Name
Person #15
Child
Adult
Child #15 Age
Submit
Should be Empty: