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Street Cats YYC Volunteer Form
Please answer all questions to the best of your ability.
25
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1
Consent for Street Cats YYC to collect your personal information. By agreeing you give permission to Street Cats yyc to collect personal information as a means to contact me for activities relating to Street Cats YYC.
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Street Cats YYC collects this personal information in accordance to the Personal Information Act.
Yes, I agree
No, I don’t agree
Other
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2
Name
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Preferred/nick name acceptable
First Name
Last Name
Pronouns
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3
Age
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4
What days of the week are you most frequently available to volunteer?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other
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5
How did you hear about Street Cats YYC?
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Instagram
Facebook
Other Social media
Friends or Family
Word of Mouth
From an Existing Team Member
Other Organizations
Other
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6
Which team member?
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7
Why does Night Outreach appeal to you?
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8
We operate from a capital H. R. Harm Reduction, rooted in social Justice. What does Harm Reduction mean to you?
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9
Do you have any previous experience with harm reduction work?
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Please explain
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10
Are you familiar with harm reduction supplies and how they are to be used?
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Yes
No
Would benefit from a refresher
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11
Are you familiar with therapeutic responses to drug poisoning and have been trained in narcan administration? Do you have any additional training?
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Yes
No
I have experience responding
I have training but have never responded
CPR
First Aid
First Responder
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12
What are your feelings towards folks who engage in ongoing substance use? Is there a risk that seeing or supporting someone during active substance use during outreach/events/or in the community could be triggering to you?
*
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As folks who are entering people’s spaces we see a high rate of use and have high rates of exposure. Please let us know if this is something that may be challenging for you.
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13
Are you aware of any triggers that you would feel comfortable sharing and any ways you’d like to be supported if an encounter triggers you?
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Many people have various triggers that they are aware of, some exposure to these can occur on outreach. If there are specific ways we can support you, we like to be prepared. You are at no obligation to share this at this time, please know that the option to share is always welcome. **please disclose if you have a fear of needles. We administer naloxone, train, and have exposure to needles frequently**
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14
Do you identify as someone with current or former substance use/dependency, street involvement, experienced houselessness, or participated in sex work?
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Yes
No
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15
Outreach to vulnerable community members can be very challenging and takes a high level of skill. Community members may be experiencing struggles with their mental wellness and/or have experience of trauma & distrust. What experiences do you bring that would help you navigate these challenges and support our community members?
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Please explain
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16
The team has a lot of moving parts that are done in the background, do you have any skills or experience that you think would be an asset to the team?
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Please explain
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17
What areas of volunteering interest you the most or would be willing to support & participate in?
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Click all that apply. Please scroll to the bottom.
Gathering Donations (access to a vehicle)
Sorting & Organizing Donations
Storing Donations
Ordering or securing Food items
Food preparation
Street Support & Distribution
Encampment Engagement & Support
Community engagement for donations
Community engagement for education purposes
Grant & Proposal Writing
Internal training opportunities
Weekend Table Distribution
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18
This group is dedicated to reducing the harms that are caused by a systemic failure for the most oppressed within our society. Our goal is to engage and build relationships with people who use substances, while providing them with safe supplies. Having food is a soft way to break barriers and provide a warm interaction. In offering my time to volunteer with Street Cats YYC, I acknowledge that; **********I am: •Fluent in Harm Reduction ideologies. •Dedicated to continuing to learn and grow in ways to reduce harm and shoulder up people who use substances, participate in sex work, or are experiencing houselessness. •Able to recognize an opioid posioning, confident in my ability to respond, provide care and administer Naloxone. •Prepared to provide space for those using substances that want a bystander to monitor during consumption to ensure no adverse events occur or can respond if necessary. •Prepared to de-escalate and be present in all interactions. *************I will: •Maintain respectful language that reduces stigma and harm. •Ensure I am maintaining a respectful distance in all interactions and am mindful of the overwhelming feeling when too many people approach an individual •Assess my mental health preparedness to appropriately engage and support PWUD. •Listen to and understand the daily debrief, and ask questions when unsure. •Hand out supplies, food, and fluids in a way that ensures as many people are being reached each night. •Stay with a partner at all times. •HAVE FUN! ***********I will NOT: •Take any photos unless discussed with leadership. •Speak on behalf of or about Street Cats YYC to media or alternative outlets without consent of the organization. •Increase risk of negative impacts by police and police presence on those that remain in the streets after our interactions. •Leave the group without notification of where I am going. •If you know anyone that is interested in getting involved, have them contact Street Cats directly before joining any Outreach activities.
*
This field is required.
By clicking yes you are agreeing to these terms if you are called upon to participate in any direct support/care/street level volunteering opportunities with Street Cats YYC in the future.
Yes, I agree to these terms and have read them to complete.
No, I do not agree with these terms.
I will not be involved in at street level supports, agree and acknowledge these terms.
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19
————————Waiver of liability———-————— This agreement releases Street Cats YYC and any other partnering organization from all liability relating to personal harm, loss of life or limb, and loss or damage to personal property that may occur to volunteers while on Outreach. I agree to hold Street Cats YYC and their partners entirely free from any liability regardless of whether the injuries or loss of property are caused by negligence. I also acknowledge the risk involved in becoming a volunteer Outreach member for Street Cats YYC. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I agree that I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity, that I have not informed leadership about. By signing below I forfeit all rights to bring suit against Street Cats YYC or their organizational partners for any reason. I will also make every effort to obey safety precautions as listed in writing and explained to me verbally. I will ask for clarification when needed.
*
This field is required.
By clicking yes you are agreeing to these terms if you are called upon to participate in any direct support/care/street level volunteering opportunities with Street Cats YYC in the future.
Yes, I agree to these terms and have read them to complete.
No, I do not agree with these terms.
I will not be involved in at street level supports, but agree to waive street cats yyc of any liability during my time volunteering.
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20
——-CONFIDENTIALITY——-Confidentiality and safety is at the core of harm reduction.Street Cats is committed to respecting the privacy, confidentiality and safety of the folks we work with and alongside, all members and volunteers have a responsibility to maintain the highest degree of confidentiality.it is important to protect our pals and our team by ensuring confidential information is not disclosed to anyone outside this group. CONFIDENTIALITY• I Agree to Not disclose Confidential Information without the consent of the Disclosing Party.• I Agree to keep personal identifying information, medical history, substance/drug use history and their activity confidential • I Agree that all information read or received in any Street Cats forums, discussions, or conversations is to remain confidential to only those within the approved team• I Agree to maintain the integrity of the work of Street Cats by ensuring the safety of those around me including team members and community members alike.
*
This field is required.
By clicking yes you are agreeing to these terms in relation to any activities with Street Cats YYC in the future.
Yes, I agree to these terms and have read them to complete.
No, I do not agree with these terms.
I will not be involved in at street level supports, but agree to waive street cats yyc of any liability during my time volunteering.
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21
Phone Number
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22
E-mail
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example@example.com
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23
Address
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Street Address
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City
State / Province
Postal / Zip Code
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Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
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Armenia
Aruba
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Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
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Sudan
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Svalbard
eSwatini
Sweden
Switzerland
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Tajikistan
Tanzania
Thailand
Timor-Leste
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Tokelau
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