Sign Up for the Ventura County PIT Count 2020

Your basic info

First Name* Last Name* Email* Phone Number* Agency/Organization (if applicable)

Your profile

Do you have reliable transportation?* Yes No Are you participating in the count as an individual, or would you like to participate as part of a group?* Individual Group If you are hoping to volunteer with family or friends, please choose a team name and have them use the same name when they register - this will help us to pair you up for the count! Have you previously participated in the count? Yes No Are you an outreach worker?* Yes No If you're not an outreach worker, are you comfortable talking to people whom are experiencing homelessness? Yes No

Deployment Center

What is your primary choice for a deployment center?* Oxnard (All Saint's Espiscopal Church 144 South C Street Oxnard, CA) Santa Paula Simi Valley (Samaritan Center Simi Valley, CA) Thousand Oaks What other areas would you be willing to volunteer? (Select all that apply)

• Oxnard
• Santa Paula
• Simi Valley
• Thousand Oaks

* Unless notified you will be reporting to the deployment site of your first preference. Thank you for your flexibility.

Emergency Contact

While we do not expect issues, we ask that volunteers identify an emergency contact. Emergency Contact Name* Emergency Contact Phone Number*

Additional Information

If you have any additional information to add, please do so here: (500 characters or less)

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