CONSENT TO RELEASE INFORMATION
By consenting to this form, you authorize Santa Cruz County to share certain personal information collected about you or your family with other disaster relief and voluntary organizations participating in the Santa Cruz County Long Term Recovery Group. Members of the Santa Cruz County Long Term Recovery Group need to share this information in order to coordinate available disaster relief services and assistance, and to reduce the paperwork and applications necessary in order for you or your family to receive disaster relief assistance and services from multiple relief organizations. All disaster relief organizations participating in the Santa Cruz County Long Term Recovery Group are committed to respecting your privacy and using the information solely for the purpose of coordinating and providing disaster relief assistance. With the exception of certain limited circumstances, it is the policy of the Santa Cruz County Long Term Recovery Group not to release information about individual or family disaster relief assistance, or other personal information obtained through the provision of disaster relief services, without the written consent of the individual or family. Therefore, we need your consent to share this information to and assist you or your family with obtaining the disaster relief services in the most expeditious and least cumbersome manner.
By checking this box I am agreeing to allow this form to be shared with the Long Term Recovery Group, County of Santa Cruz, City of Watsonville, FEMA, CalOES, Community Bridges and Catholic Charities.