Family Connect Volunteer Registration 2017
Volunteers are needed to help host the 2017 Family Connect on Saturday, May 6th 2017. All volunteers will be asked to sign a liability waiver upon check-in. Family Connect will be held at Valley High School, 2839 S. Burnham Ave. Las Vegas, NV 89109.
Last Name *
Your answer
First Name *
Your answer
I am 16 years of age or older *
Volunteers must be at least 16 years of age to register
Email Address *
Your answer
Phone *
Your answer
Are you volunteering on behalf of an Organization/Corporate Team?
If yes, please list the name of the Organization/Corporation
Your answer
Which volunteer shifts do you plan to participate in? *
Please select the shift that you plan to participate in.
Required
May we add you to our email list?
Languages Spoken Fluently
(Translators may be needed as a concierge service)
Your answer
Consent to Participate and Release of Liability *
This organization/individual understands that it/he/she is participating in activities related to Family Connect 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 Clark County School District from any liability for an injury or illness to this organization/individual during its/his/her participation with Family Connect. 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 Family Connect, 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 Clark County School District 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, Clark County School District, the Cities of Las Vegas, Henderson, North Las Vegas, and Boulder City 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 Family Connect. This organization/individual agrees to return all forms and data sheets to Family Connect staff upon completion of its/my participation in Family Connect.
Please read and sign the "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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