Veterans Village of San Diego 2024 Stand Down Participant Registration Form Register NOW for Stand Down 2024 – August 9-11. **All information submitted is confidential and will not be sold/shared. Stand Down ApplicationParticipant InformationLast Name First Name Middle Name AKA Phone Number Email Address Date of Birth Social Security Number Age AddressAddress Line 1 Address Line 2 City State Zip Code Race: American Indian/Alaska Native Asian Native Hawaiian or Pacific Islander Black/African American White/Caucasian Multi-Racial OtherEthnicity: Hispanic Non-HispanicGender Male Female Transgender Non-Binary Other Prefer Not To SayAre you or any of your attendees a registered sex offender and/or a convicted arsonist? Yes NoStatus Veteran Spouse of a VeteranMilitary Service (COMPLETE FOR VETERAN ONLY)Branch of Service: Army Marine Corps Navy Air Force Coast Guard Active ReserveAre you a combat veteran? Yes NoService Start Date: Discharge Date: Rank at Discharge: Where did you serve? Have you applied for VA benefits? Yes NoAre you service connected? Yes No% Connected? 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Type of Discharge Honorable General, under Honorable Other than Honorable Bad Conduct DishonorableHave you ever experienced a Traumatic Brain Injury? (TBI) Yes NoIf yes, was TBI experienced in combat? Yes NoAll ParticipantsHighest grade level completed: None Some high school High School Graduate Some College Trade/technical/vocational training Associate degree Bachelor’s degree or higherAre you employed? Yes NoAre you under employed? Yes NoWhat is your Occupation: Are you currently experiencing homelessness? Yes NoIf No: Are you at risk of becoming homeless in the next: 30 days 60 days 90 daysIf yes: How long have you been homeless? Less than 12 months 1 to 2 years 2 to 3 years more than 3 yearsHave you experienced homelessness in the past? If yes, When: 0-2 years ago 2-4 years ago 4-6 years ago more than 6 years agoWhere do you sleep? Car Emergency Shelter Housing Program Couch Surf Street ParkHow many Stand Downs have you attended in the past? Which nights do you plan to attend Stand Down 2024? Night 1 - Friday August 9, 2024 Night 2 - Saturday, August 10, 2024 Both Night 1 and 2Which of the following services are you most in need of (check all that apply)? Mental Health Treatment Substance Abuse Services Medical Services Housing Employment and Job Development Dental Services Legal and/or Homeless CourtIf available, will you need a bed once Stand Down concludes? Yes NoHow did you hear about Stand Down 2024? VVSD Website Social Media Non-VVSAD Referral VA VVSD Outreach Team Radio OtherAre you interested in participating in future advocacy efforts to help end Veteran homelessness? Yes NoHomeless Court (ALL PARTICIPANTS)If you are not familiar with Homeless Court, and have tickets, warrants, drivers license issues, child support issues, etc. please note that here and see a court advocate at the event. They may be able to assist you in getting these expunged!Request Homeless Court? Yes NoDo you have any outstanding warrants? Yes NoHave you attended Homeless Court before? Yes NoHow many times have you used Homeless Court? Please describe the legal problem you wish to resolve at Homeless Court: Child Support case with DCSS? Yes NoOther Child Support Cases? Yes NoDo you need legal advice? Yes NoDependents: Spouse (each participating spouse must complete an application)Is your spouse attending Stand Down? Yes NoLast Name First Name Middle Dependents: Under 18Will any dependents under the age of 18 be attending Stand Down with you? Yes NoName (First and Last) Age Gender Name (First and Last) Age Gender Name (First and Last) Age Gender Name (First and Last) Age Gender If you have additional dependents attending, please list name, gender, and age here: PetsWill you be bringing a pet? Yes NoPet name Type of Pet Will you be bringing a crate or do we need to provide one? Will you want veterinarian care for your pet? Yes NoEmergency Contact [MANDATORY]This can be a relative, friend, case manager, etc.First Name Last Name Relationship Phone Number: Additional Information Upon registration or entry to event, I understand the risks associated with being in a public space and contagious viruses may be present. I hereby choose to accept the risk of contracting COVID-19 in order to attend the event. During STAND DOWN, VVSD and its affiliated may take photographs or videos in which your likeness is captures. By participating, you grant these organizations permission to use your likeness in their publications and websites without payment or other consideration. You further agree to relinquish and rights in these materials, including any right to inspect or approve them before publication and any right to royalties or compensation arising from or related to their use. You also agree that these materials may be altered, copied, distributed, and otherwise used to publicize the community activities or VVSD and its affiliated. You also authorize VVSD to transfer these photographs and videos to any third part to be used for any lawful purpose. Participant Code of Conduct All participants at Stand Down are expected to adhere to a code of conduct that ensures a safe and respectful environment for all. All participants are expected to remain civil and considerate in their interactions with volunteers and other Stand Down participants. The use of illegal substances and alcohol is prohibited during the event. Participants are not to bring weapons of any kind to the event and fighting or any act of violence is not acceptable and will not be tolerated. All participants are expected to treat each other and all volunteers with respect and dignity while in attendance at Stand Down. Adherence to this code of conduct will allow for a positive and secure atmosphere for everyone involved. I do hereby hold harmless and release from responsibility, Veterans Village of San Diego, County, City of San Diego and other support and service providers for any and all injury to myself and any members of my family, be it self-inflicted or as a result of others while a participant at Stand Down. I ackowledge that all information collected on this form is confidential and will only be used for the purpose of Stand Down.Please Type Your Full Name Date Submit Form
