Volunteer with CT Coalition to End Homelessness

Central Youth Outreach and Count

January 23rd - 29th, 2019
Choose your shifts below
Already signed up? Click here to check your status.


What's your email address?

We need your email so we can communicate with you.

Your information

Required fields are marked with an asterisk (*)
name *
phone number *
Are you affiliated with an organization or legislative office? If so please detail


Youth Count 2019

Volunteer Release and Confidentiality Form

First and Last Name:
City, State, Zip:

Phone: E-mail: Agency Affiliation (if any):

By signing below, I understand that I represent to the CENTRAL

Continuum of Care that I am over the age of 18. I hereby agree to hold harmless and release the CENTRAL Continuum of

Care; its member organizations, their boards/trustees, employees, volunteers, count organizers; and other participants in the Connecticut Youth Count from any liability for any accident, injury or death or any theft or loss of property arising from the participation as a volunteer in the Youth Count, regardless of whether incurred as a result of negligence or other. I voluntarily assume these and any other risks in participating in the count and waive all claims and causes of action that may arise out of participation in the count.

I understand that as a volunteer for the Youth Count it will be necessary for me to handle and process confidential information. I acknowledge that I will keep all information confidential while a volunteer and that it is my responsibility to keep this information confidential even after I end my volunteer duties for the Youth Count. I understand that I am not to disclose any identifying confidential information and/or records or to engage in casual or informal conversation identifying any individual involved in the count.

I have read and fully comprehend the information pertained in this form and agree to the terms of this release. By signing below I acknowledge that it is my responsibility to comply with all relevant laws, policies, and regulations concerning access, use, maintenance and disclosure of information made available to me as a volunteer in the Youth Count.

Signature Date