Pop-Up PHC Volunteer Registration
Volunteers are needed for Pop-Up Project Homeless Connect!

Duties will include:
Setting up tables, chairs, and tents
Signing up participants for available services
Navigating participants through available services
Breaking down tables, chairs, and tents

2018 Pop-Ups:

- July 17, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2:00 pm
- August 21, 2018 - The Salvation Army @ 35 West Owens Avenue, 11:00 am - 2:00 pm
- September 18, 2018 - TO BE DETERMINED, 10:00 am - 2:00 pm
- October 16, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2: 00 pm
- Project Homeless Connect 2018 - NO POP-UP
- December 2018 - TO BE DETERMINE

Registrants will receive an informational e-mail the week prior to the event.

First Name *
Your answer
Last Name *
Your answer
Dates *
Indicate the date(s) you would like to volunteer. Select all that apply.
Required
I am 16 years of age or older. *
Volunteers must be at least 16 years of age to register.
E-mail Address *
Your answer
Phone Number *
Your answer
Are you volunteering on behalf of an organization or corporation?
If yes, please enter the name of the organization or corporation.
Your answer
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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