Family Connect 2018 Volunteer Registration
More than 100 volunteers are needed at Family Connect!
Wednesday, April 11, 2018
Cambridge Recreation Center 3930 Cambridge Street Las Vegas, NV

Volunteer duties include: navigation, participant check-in, participant check-out, food service, Connect Store, parking assistance, courtesy and trash patrol, and more. For more information, please see the Family Connect 2018 Volunteer FAQs at: www.nevadahomelessalliance.org/familyconnect

Volunteer shift options include:
- Shift 1: 10:30 am - 1:30 pm (set-up)
- Shift 2: 1:30 pm - 4:30 pm (event)
- Shift 3: 4:00 pm - 8:00 pm (event and clean-up)
- Shift 4: 10:00 am - 8:00 pm (all-day)

**ATTENTION: Certain volunteer roles at the event require specialized volunteers with training in healthcare related fields, including collecting participant data necessary for healthcare follow-up. If you are a student, have an education or background, or are currently working in a field such as medicine, dentistry, optometry, social work, psychology, or related, your specialized knowledge/skills are needed! PLEASE DO NOT COMPLETE THE FORM BELOW. Instead, register here: https://unlv.co1.qualtrics.com/jfe/form/SV_0xIowpGUwMPeue9. For more information on specialized volunteering, contact Dr. Laura Culley at laura.culley@unlv.edu or (702) 895-0325.

Email address *
First Name *
Your answer
Last Name *
Your answer
Are you 16 years of age or older? *
Volunteers must be 16 years of age or older.
Organization
Are you volunteering as part of a group or organization? If yes, please enter the name of the group or organization.
Your answer
E-mail *
Your answer
Phone Number *
Your answer
Shirt Size *
Accommodation(s)
Do you require any accommodations? If yes, please enter a brief description.
Your answer
Volunteer Shift(s) *
Select all that apply. Please plan on arriving 15 minutes prior to the shift(s) you indicate to allow for check-in, role assignment, and training.
Required
Training *
Advance training for volunteers is highly encouraged. Are you able to attend volunteer training on Saturday, April 7, 2018 at Cambridge Recreation Center from 1:00 pm to 3:00 pm? If you are unable to attend advance training, we still need your help and will assign you a role when you check-in at the event for the shift(s) you indicated above.
Consent to Participate and Release of Liability *
This organization/individual understands that it/he/she is participating in activities related to the event by its/his/her own choice. This organization/individual agrees to release the Nevada Homeless Alliance, Clark County, the Cities of Las Vegas, Henderson, North Las Vegas, and Boulder City, and participating agencies from any liability for an injury or illness to this organization/individual during its/his/her participation with the event. We/I assume full responsibility for risk of bodily injury or property damage incurred by the organization/myself arising either directly or indirectly from its/my participation in the event, from any cause whatsoever, whether caused by the Nevada Homeless Alliance, Clark County, the Cities of Las Vegas, Henderson, North Las Vegas, and Boulder City, and participating agencies active or passive negligence or otherwise. This organization/individual understands this release extends to claims that it/I do(es) not know or do(es) not expect to exist at the time of signing of this release. This organization/individual agrees to indemnify, defend and hold harmless the Nevada Homeless Alliance, Clark County, the Cities of Las Vegas, Henderson, North Las Vegas, and Boulder City and participating agencies for any liability that may arise as a result of this organization’s/individual’s criminal, willful or fraudulent acts, or omissions that occur during its participation in the event. This organization/individual agrees to return all forms and data sheets to the event staff upon completion of its/my participation in the event.
Oath of Confidentiality Agreement *
The Nevada Homeless Alliance, Clark County, Clark County School District, the Cities of Las Vegas, Henderson, North Las Vegas, and Boulder City respects the privacy and privacy rights of the people they serve. This organization/individual understands that: 1. The purpose of gathering and sharing private information between survey and service team members is to improve housing and health outcomes for the clients served at Family Connect. 2. Sharing of personal client information will be limited to that which will help achieve this purpose. 3. The unauthorized release of any protected health information may make us/me subject to a civil action for damages. In addition, Federal and State laws protecting information relating to the provision of confidential patient information, including, but not limited to, mental health and substance abuse information may apply. These laws may have additional penalties, including criminal penalties.
Consent to Photography and/or Interview *
This organization/individual hereby agrees that its participants or I may be interviewed and/or photographed/videotaped and that the interview and/or photos/videos are obtained with our/my full knowledge. This organization and its participants/I understand the interview and/or photos/videos that are obtained can be used for the Nevada Homeless Alliance promotional materials without any compensation of any kind being furnished to this organization or its participants/I.
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