🌸 Her Essentials Project

Apply for a Her Essentials Kit

Hygiene support kits for girls and young women ages 10+ in Virgin Gorda. Confidential, respectful, and free.

1. Applicant information

Full name *

Age *

Date of birth *

Community / District *

School (if applicable)

Grade / Form (optional)

Contact phone *

Email (optional)

I confirm the applicant currently resides in Virgin Gorda. This project is reserved for Virgin Gorda residents.

Parent / guardian full name

Relationship to applicant

Contact phone

People in household *

Women & girls in household *

School-aged children *

Your answers are confidential and only used to prepare your kit.

Have you started your menstrual cycle?

Yes No Prefer not to answer

Would receiving a hygiene support kit be beneficial? *

Yes No

Anything you would like us to know when preparing your kit? (Optional)

Would you like to hear about future Bloom Together programs for girls and young women? *

Yes No

I confirm the information above is true and consent to Bloom Together contacting me about this application.