Lahaina Resource and Recovery Center (LRRC)
HOME FURNISHINGS APPLICATION

Please fill out this form to register to receive services from LRRC which include Furnishings, some Daily Essentials and Non-Perishable Foods. We do not offer financial services or housing.
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Seeking Services
Which services are you seeking?  We do not offer financial services or housing.
PRIMARY RESIDENT NAME
*
PRIMARY RESIDENT GENDER
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PRIMARY RESIDENT ETHNICITY
PRIMARY RESIDENT - PART HAWAIIAN? *
We gather this only because of possible funding resources that support specific ethnic demographics.
CONTACT INFO
PHONE *
EMAIL
SECONDARY RESIDENT NAME
NO. OF DISPLACED FAMILY MEMBERS
*
MEMBERS OF HOUSEHOLD
TOTAL NUMBER OF ADULTS (OVER 18 YEARS)
TOTAL NUMBER OF CHILDREN (UNDER 18 YEARS)
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