2015 Southern Nevada Homeless Census Volunteer Registration
Volunteers are needed to help with the annual count of our community's homeless population. Volunteers will travel into our census tracts and perform a visual count of our homeless population. PLEASE NOTE THAT ALL VOLUNTEERS ARE ASKED TO REPORT TO THEIR DEPLOYMENT STATIONS BY 11:30 PM ON THE NIGHT OF JANUARY 27TH, 2015 TO VOLUNTEER IN TO THE MORNING HOURS OF JANUARY 28TH, 2015.  
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First Name *
Last Name *
Address *
City, State, Zip Code *
Phone # *
If applicable, please list the name(s) of your employer
Email Address *
Age *
Youth ages 14-17 may volunteer if accompanied by an adult.
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We strongly encourage volunteers to attend the Advanced Volunteer Training on January 22nd, 2015   *
Trainings will be held at Clark County Chambers, 500 S. Grand Central Pkwy
Volunteers may choose from any of the following 5 deployment station locations throughout the Vegas Valley. *
Volunteers will report to their deployment stations by 11:30 pm on the night of January 27th and volunteer into the morning hours of January 28th, 2015.
How did you hear about this volunteer opportunity? *
Please check all that apply
Required
Are you able to use your vehicle for this volunteer opportunity? *
Volunteers are asked to drive to various areas in the valley to count homeless individuals.
Please choose from one of the following volunteer duties *
1) Drivers (must have a car), who will drive around the census tract with a partner volunteer to gain accurate counts and 2) Walkers, who will walk in pairs through the census tract and perform a visual count.
Required
Have you participated in the homeless census count in previous years? *
Are you interested in being contacted for similar volunteer opportunities in the future? *
Please read  the Volunteer Hold Harmless Agreement below if you wish to participate. *
I understand that my participation in the 2015 Southern Nevada Homeless Census is purely voluntary, and I agree to hold harmless Clark County, and all officers, employees, and authorized volunteers, for any and all liability due to accident, illness, damages, injuries, death or other consequences that I might sustain resulting directly or indirectly from my participation in this activity.  I have been informed, and I know that my participation involves some amount of risk.  I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of another participant.  If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazards to the attention of an authorized representative.  This release and hold‐harmless statement shall also be binding on my heirs, assigns, successors, and all other persons who may claim through me.
Electronic signature *
By signing this electronic form you are confirming that you have read and confirmed your agreement with the above policies and procedures for 2015 Southern Nevada Homeless Census.
Please list any comments, concerns, special requests or accommodations you may need.  
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