Madera 2025 Homeless Point in Time Count

As part of your work with the Fresno Madera Continuum of Care you may have access to view, update or modify sensitive information. You must treat this information as confidential and not share with anyone unless specifically authorized.

The Point-in-Time Count (PIT) defines Sensitive Information as:

• Client names, nicknames or any other identifying information
• Client address, location or whereabouts
• Client personal finance information including social security numbers, financial data or related information
• Client health information including information on medical conditions, treatment or history

All information collected access or viewed, as part of the Unsheltered Count Survey is to be treated as confidential in written, electronic, printed and all other forms. Information is the shared property of the Campaign and the entity signing this agreement and should not be released, shared or discussed without prior authorization. This includes communication in any form with clients, co-workers, researchers, outside agencies or any other party.

In the event that you are unsure if information can be shared, DO NOT DISCLOSE INFORMATION, contact your immediate supervisor or the Fresno Madera Continuum of Care to obtain approval.

Unauthorized disclosure of information may result in disciplinary or legal action or may result indismissal.

 As a participant in the Point-in-Time Count I understand that I may have access to sensitive information as defined by the campaign. I agree to maintain the security and confidentiality of survey and related information as well as the security of the Survey Database systems. I will not disclose, share, publish, copy or distribute any survey without express permission.

In consideration for being allowed to participate as a volunteer in the Fresno Madera Continuum of Care (FMCoC) Point-in-Time (PIT) count, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the FMCoC, Fresno Housing Authority, VA Medical Center, Neilsen Center, Fresno EOC, and collectively its’ contractors, employees, officers, directors, volunteers and agents (here to known as FMCoC PIT Leadership Team) from any and all claims, including claims of negligence resulting in any physical or psychological injury (including paralysis and death), illness, damages or economic or emotional loss I may suffer because of my participation in the PIT count and Survey Process, including travel to and from and during the PIT count. 

I am voluntarily participating in the PIT count.  I am aware of the risk associated with traveling to/from and participating in PIT count, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death.  I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the PIT count and PIT count location(s).  Nonetheless, I assume all related risks, both known or unknown to me, of my voluntary participation in the PIT count, including travel to, from and during the PIT count. 

I agree to hold the FMCoC Leadership Team harmless from any and all claims, including attorney’s fees or damage to my personal property that may occur as a result of my voluntary participation in the PIT count and PIT count, including travel to, from and during the PIT count. If the FMCoC Leadership Team incurs any of these types of expense, I agree to reimburse the FMCoC Leadership Team.  If I need medical treatment, I agree to be financially responsible for any cost incurred as a result of such treatment.  I am aware and understand that I should carry my own health insurance. 

In consideration for my acceptance as a participant the PIT count, and the services and amenities to be provided by the FMCoC Leadership Team in connection with the PIT count, I confirm my understanding that:

• I have read any rules and conditions applicable to the PIT count made available to me and I acknowledge my participation is at the discretions of the FMCoC Leadership Team.
• The PIT count officially begins and ends at the locations(s) designated by the FMCoC Leadership Team.  The PIT count does not include carpooling, transportation, or transit to and from the PIT count, and I am personally responsible for all risk associated with this travel.
• If I decide to leave early and not to complete the PIT count as planned, I assume all risk inherent in my decision to leave and waive all liability against the FMCoC Leadership Team arising from that decision.  Likewise, if the FMCoC Leadership Team has concluded the PIT count, and I decide not to return to the end location designated by the FMCoC Leadership Team, I assume all risk inherent in my decision to go forward and waive all liability against the FMCoC Leadership Team arising from that decision.
• This Agreement is intended to be as broad and inclusive as is permitted by law.  If any provision or any part of the Agreement is held to  be invalid or legally unenforceable for any reason, the remainder of the Agreement shall not be affected thereby and shall remain valid and fully enforceable
• To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITY the FMCoC Leadership Team, its officers, directors, employees, agents, and leaders from any and all liability on account of, or in any way resulting from Injuries and Damages, even if caused by negligence of the FMCoC Leadership Team, its officers directors, employees, agents, and leaders, in any way connected with the PIT count.  I further agree to HOLD HARMLESS the FMCoC Leadership Team, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or losses caused by my own negligence while a participant in the PIT count.  I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns.
• I have read this document in its entirety and I freely and voluntarily assume all risk of such Injuries and Damages and notwithstanding such risk, I agree to participate in the PIT count.

I do hereby consent and agree that the FMCoC Leadership Team, its employees, or agents have the right to take photographs, videotape, or digital recordings of me beginning on Tuesday, January 28, 2023 at 5:30pm and ending on Thursday, January 30, 2023 at 5:00pm, and to use these in any and all media, now or hereafter known and exclusively for the purpose of PIT count.  I further consent that my name and identity may be revealed therein or by descriptive text or commentary. 

I do hereby release to the FMCoC Leadership Team, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. 

I am 18 years or older.  I understand the legal consequences of signing this document, including (a) releasing the FMCoC Leadership Team from all liability, (b) promising not to sue the FMCoC Leadership Team (c) and assuming all risk of voluntarily participating in the FMCoC Leadership Team, including travel to, from and during the PIT count and Survey Process.

I understand that this document is written to be as broad and inclusive as legally permitted by the State of California.  I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.

I have read this entire document and I am signing it freely.  No other representations concerning the legal effect of this document have been made by me.