Sign Up for the 2022 Point in Time Count Humboldt County

Your basic info First Name* Last Name* Email* Phone Number*

Additional info Are you participating in the count as an individual, or would you like to participate as part of a group?* If you are hoping to volunteer with family or friends, please choose a team name and have them use the same name when they register - this will help us to pair you up for the count! Would you be comfortable assuming the risk of being in the same car with the people in your group? We assign individuals to small teams. If necessary, would you be comfortable being in a car with a randomly assigned teammate or would you prefer to only be assigned to a location where you will be walking outside with a teammate? Are you an outreach worker?* If you're not an outreach worker, are you comfortable talking to people whom are experiencing homelessness?

Your profile Do you have reliable transportation?* If yes, do you have a vehicle you are willing to volunteer for the PIT Count? Have you previously participated in the count? Are you willing to be a team leader? Responsibilities might include choosing a meet-up location, confirming everyone on your team is set up with the mobile app, and at the end of the count confirming everyone on the team has submitted all surveys. Do you have a smart phone that you would be willing to use to help collect survey information during the count?

COVID-19 Concerns Are you in need of PPE (personal protective equipment) for yourself?

Regional Hubs Which regional hub is your primary choice?* What other regional hubs would you be willing to be assigned to? (Select all that apply)

Arcata
East County
Eureka
Fortuna
Garberville
McKinleyville

* Unless notified you will be reporting to the count area of your first preference. Thank you for your flexibility.

Volunteer Release and Waiver of Liability Form

I desire to work as a volunteer for the Humboldt Housing and Homeless Coalition (HHHC) during the 2022 Point-in-Time Count.

I understand that the scope of my relationship with the HHHC is limited to a volunteer position, that I will not receive employee compensation from the HHHC and that I will not have nor will I acquire any employee rights or employee benefits of any kind from the HHHC.

I understand that my participation as a volunteer and the use of County facilities is voluntary and is not being done at the direction of any County elected official, officer, employee, or agent.

I have been informed and recognize that my services as a volunteer may require physical activity. I have been informed that before beginning any program of physical activity, I should have a thorough physical examination by a physician who has been informed of my proposed participation as a volunteer and who is completely aware of my physical condition.

I acknowledge that I fully understand my services as a volunteer may involve risk of serious injury, death, or property damage, including losses which may result not only from my own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, or the condition of the facilities, equipment, or areas where my services as a volunteer are being rendered.

Knowing and understanding the risks involved with my services as a volunteer, I hereby voluntarily and willingly assume responsibility for all risks and dangers associated with my service as a volunteer except as expressly stated in this Release.

I understand that the HHHC, its elected officials, officers, employees, agents, and other volunteers ("Releasees") do not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to worker's compensation, medical health or disability benefits or insurance. I expressly waive any claim for compensation or liability of any kind on the part of the Releasees.

I hereby release, discharge, hold harmless, and agree not to sue, and to indemnify Releasees from any and all demands, actions, suits, and claims which I have or that might accrue to me and from any and all damages which may be sustained by me or for any injury, death, or damage to or loss of personal property arising out of, or in connection with, my participation in the Activity from whatever cause, including the active or passive negligence of Releasees or any other participants in the Activity.

I have carefully read this Release and understand its contents. I am aware that this Release is a release of liability and voluntarily execute it. My signature on this document is intended to bind not only myself, but also my heirs, administrators, executors, and assigns. The undersigned expressly agrees that this Release is intended to be as broad and inclusive as permitted by California law.

Signature* Date*

Volunteer Confidentiality Form

As a volunteer with the Point-in-time count, you will encounter community members that are homeless, have an illness, or are experiencing challenging times in their life. Some may complete the survey with little interaction while some may share their entire life story with you.

Respecting the privacy of our community member, staff, and volunteers is a priority for the Humboldt Housing and Homeless Coalition (HHHC). Personal, health and financial information is confidential and should not be disclosed or discussed with anyone. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion of confidential information and that documents containing confidential information are not left in the open or inadvertently shared.

Staff and volunteers will be exposed to information which is confidential in nature. It is the policy of the HHHC that such information must be kept confidential both during and after volunteer service. Staff and volunteers are expected to return any paper surveys at the end of your shift.

As a volunteer for the PIT count, it is prohibited to:

Take pictures of homeless encampments or people experiencing homelessness
Take pictures in or outside of shelters, and community events servingpeople experiencing homelessness
Post pictures and stories on social media
Text or email stories or pictures
Discuss your thoughts on what someone has "done wrong" in their life
Speak poorly of persons you've encountered, or
Instilling your personal views and/or religious beliefs on other volunteers and community members.

I understand that all information obtained during the count is confidential and is to be only used for the purpose of counting and collecting information on the characteristics of people experiencing homelessness.

I have read and fully understand the information contained in this form and agree to the terms of this document.

Signature* Date*

Emergency Contact While we do not expect issues, we ask that volunteers identify an emergency contact. Emergency Contact Name* Emergency Contact Relationship* Emergency Contact Phone Number*

Additional Information If you have any additional information to add, please do so here: (500 characters or less)