Point-In-Time (PIT) Count Registration
Event Timing: January 25th, 2023, 7pm-Midnight
Macomb County
Contact Event Organizer - Kristin DeFranco
(586)817-2049 or kristin.defranco@macombgov.org

Hello! Thank you for taking the time to volunteer for the PIT Count in Macomb County!

During the PIT count, we are tasked with counting everyone in our community who is experiencing homelessness. We want to understand the total number of homeless people and some demographic and other information about them. You will assist us by helping us count the unsheltered homeless, as required by the Department of Housing and Urban Development.  

You will be assigned a geographic location to canvass including any known areas where you might be able to find some homeless people. You will attempt to complete a survey form and have a conversation with those you encounter to try to obtain information about them. Incentives will be provided to give to those you speak with as well as a list of resources. 

There will be a required training course you must complete, more than likely a virtual session in January before the count. Ideally, you will work in teams of 3 to 4 people per vehicle the night of the count. 

Email *
Name *
Organization - if applicable
Are you able to attend on Wednesday, January 25th, 2023, between the hours of 7pm and Midnight?  *
Required
Have you participated in a count night before?  *
Would you be interested in being a Team Lead? Every team needs an identified point-person. This person handles communication with headquarters the night of the PIT, obtains the supplies for your team, and ensures surveys are completed and turned in timely.  *
Do you have a specific area of the county you prefer to volunteer? If so, please describe it here, and if possible (not promised!), we will get you there. 
Do you have other team members in mind already? (Talk about a super-volunteer!) If so, please list them here so we can keep you all together if possible.
Release of Liability and Consents
Please review the following and acknowledge.


Voluntary Assignment: Point-In-Time Count.

In consideration of accepting the above listed voluntary assignment with the County of Macomb, Macomb Community Action, I do hereby, release the County of Macomb and its Officials, Agents and Employees of the County from liability for any personal injury, bodily injury and/or damage to property which I may suffer while participating in the above listed voluntary assignment. This includes all risks that are connected with this activity whether foreseen or unforeseen. I agree to accept all medical expenses for any and all medical services of which I may receive as the result of injury to myself while participating in the above listed voluntary assignment. It is further mutually agreed and understood that the above listed voluntary assignment is not intended to be of a permanent nature, but rather for a voluntary purpose for a limited period of time.

By signing this document in an electronic format and by providing my electronic signature in the space below, I acknowledge and agree to conduct this transaction by electronic means, and my electronic signature below is my overt act demonstrating my intent to be bound by this agreement. I acknowledge that Macomb Community Action also agrees to conduct this transaction by electronic means.

By signing this agreement I fully understand and agree that I am not entitled to or shall receive any benefits to which County employees are entitled, including but not limited to, overtime, retirement benefits, worker’s compensation and injury leave benefits. I am of lawful age and legally competent to sign this agreement.
I have read the above statement and I understand the terms of this agreement and sign this document as my own free act. Please type your name below:  *
Privacy and Confidentiality: Protection of Client Privacy
Point-In-Time Count volunteers will comply with all applicable federal and state laws regarding protection of client privacy. Volunteers will comply specifically with Federal confidentiality regulations as contained in the Code of Federal Regulations, 42 CFR Part 2, regarding disclosure of alcohol and/or drug abuse records, the Health Insurance Portability and Accountability Act of 1996, 45 C.F.R., Parts 160 & 164, and corresponding regulations established by the U.S. Department of Health and Human Services, and all privacy rules specified in Michigan Mental Health Code/Public Act 258, State of Michigan Confidentiality Statutes, Administrative Rules for Michigan Substance Abuse Programs/Public Act 368, Victim-Counselor Privilege MCL 600.2157(a), Michigan Public Health Code/Title 14 of MCL 14.15(1101) regarding HIV/AIDS, State of Michigan Child Protection Laws/Public Act 238 Sections 722.621 through 722.636, and State of Michigan Vulnerable Adults Protection Law 405/MCL 400.11(a)(1).
I have read the above statement and I understand the terms of this agreement and sign this document as my own free act. Please type your name below:
 *
Can we count on you to provide any donation items for the PIT? We will provide the homeless people we encounter with a goody bag of items. We are searching for bags themselves to put the items in, winter accessories like gloves, hats, scarves, and coats, grab & go packaged food items, hygiene products, and blankets.  
If you can acquire any of these items over the next few months please contact Kristin DeFranco to coordinate pick-up/delivery. 
Once completed, you will be contacted via email as we get closer to the count date. You will be required to attend a brief training prior to engaging in the count. More details to come. 

Are there any questions you have for us? If so, please list them here and we will address them within our next email. Thank you for volunteering to ensure, "Everyone is Counted" in Macomb County!
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