Hardship Request Submittal

You acknowledge and agree that providing personal information to VineBrook is entirely voluntary. VineBrook shall be free to use such personal information in connection with the Hardship Program and other services provided to you. VineBrook may also share or disclose such personal information to its vendors, affiliates, agents, advisors or service providers. Unless prohibited by applicable law, you acknowledge and agree, and hereby waive and release VineBrook from any claims or liabilities arising from or in connection with the personal information, or with your application to participate in the Hardship Program. You agree you shall not bring or participate in any class action or other class proceeding, including class arbitration, in connection with any dispute arising from or in connection with the Hardship Relief Program or the personal information disclosed.

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