The URL can be used to link to this page

Home My WebLink About09-04-2012 pc slo county stand downanta •Barbara Count y For more info/volunteer contact County of .B . 5th District Supervisor Steve Lavagnino at 805-3 4W W W•CO u Y t 9-ran1 4 4 OW v CO COUNCIL FETING .9 'TEM N SANTA BARBARA COUNTY VETERAN STAND DOWN PARTNERS AND SERVICE PROVIDER S (REVISED +SEP-12 ) 1.Alcohol Drugs and Mental Health Services_ 2.All American Screen Printin g 3.Allan Hancock Colleg e 4.American GI Foru m 5.American GI Forum Youth Corp s 6.American Legion Post 371 Guadalup e 7.American Linen Rental and Cleaner s 8.American Red Cross 9.Board of Equalization Consumer Advocat e 10.California Conservation Corps 11.California Department of Motor Vehicle s 12.California Department of Rehabilitatio n 13.California Department of Veteran Affairs Cal Ve t 14.California Employment Development Departmen t 15.California Natl Guard Family Assistance Networ k 16.Camp San Lui s 17.Casa Esperanza Homeless Cente r 18.Catholic Charitie s 19.Center for Employment Training 20.Central Coast Commission for Senior Citizens 21.Central Coast Vietnam Veterans 98 2 22.Chumash 23.City of Santa Mari a 24.Community Action Commission of Santa Barbar a Count y 25.Community Action Partnershi p 26.Community Health Centers of the Central Coas t 27.Dignity Healt h 28.Direct Relief Internationa l 29.Disabled American Veterans Post 8 2 30.Express Employment Professional s 31.Franchise Tax Board Tax Advocat e 32.Gold Coast Senior Options & Dementia Care Assoc . 33.Good Samaritan Shelter 34.Grizzly Academ y 35.Honda of Santa Mari a 36.Housing Authority of Santa Barbara County 37.IBEW 38.Image Factory 39.Independent Living Resource Cente r 40.InDyne Inc . 41.Internal Revenue Servic e 42.La Verne Universit y 43.LeBard's Computer Center 44.Legal Aid Foundation of Santa Barbara Count y 45.Lompoc Valley Chamber of Commerc e 46.Marine Corps League Det . 1340 47.Maxine Lewis Memorial Shelte r 48.Merrill Garden s 49.North County Rape Crisi s 50.Orcutt American Legion Rider s 51.People's Self Help Housing 52.PG&E 53.Pierre Claeyssens Veterans Museum and Librar y 54.Pods Moving and Storag e 55.San Luis Obispo Vet Cente r 56.Santa Barbara Business Colleg e 57.Santa Barbara County Alcohol and Drug Program s 58, Santa Barbara County Animal Contro l 59.Santa Barbara County CEO 's Office 60.Santa Barbara County Department of Child Suppor t Service s 61.Santa Barbara County Department of Social Service s 62.Santa Barbara County District Attorney's Offic e 63.Santa Barbara County Probatio n 64.Santa Barbara County Public Defender 's Office 65.Santa Barbara County Public Health Departmen t 66.Santa Barbara County Superior Cour t 67.Santa Barbara County Veterans Service s 68.Santa Barbara Elks Lodg e 69.Santa Barbara Foundatio n 70.Santa Barbara Salvation Army Hospitality Hous e 71.Santa Maria American Legion Post 5 6 72.Santa Maria Breakfast Rotar y 73.Santa Maria Economic Development Comm . 74.Santa Maria Elks Lodg e 75.Santa Maria Fairpar k 76.Santa Maria Noontime Kiwani s 77.Santa Maria Salvation Arm y 78.Santa Maria Valley Chamber of Commerc e 79.Santa Maria YMCA 80.Sempra Energy 81.Silverado Stage s 82.SMOOTH, Inc . 83.Social Security Administratio n 84.Sport Clips Haircut s 85.Toyota of Santa Mari a 86.Transitions Mental Healt h SANTA BARBARA COUNTY VETERAN STAND DOWN SUPERVISOR STEVE LAVAGNIN O 511 EAST LAKESIDE PARKWAY, SUITE 141, SANTA MARIA, CA 934 5 5 (805) 346-8400 WWW .SBCOUNTYST'ANDDOWN .COM Page 1 87.University of Phoeni x 88.US Department of Veterans Affair s 89.US Forest Service 90.VA Santa Maria and San Luis Obispo CBOC s 91.Vandenberg Air Force Base 92.Vandenberg American Legion Post 12 5 93.Veteran Services Commissio n 94.Veterans of Foreign Wars Post 252 1 95.Veterans of Foreign Wars Post 57 0 96.Volt Temp Service s 97.Vons 98.Welcome Home Troops Santa Mari a 99.Workforce Investment Boar d 100.Workforce Resource Center Career One Stop DATE OF BIRTH BRANCH OF SERVICE AGE GENDER FROM / TO / Santa Barbara County Veteran Stand Dow n October 13, 2012, Gates Open 7 a.m .-3 p .m . Santa Maria Fairpark, 937 South Thornburg Street Santa Maria, C A Pre-registration not required but recommende d Limited to first 500 veterans, legal spouse and dependent children under age 1 8 FOR MORE INFORMATION CALL, (805) 346-840 0 DRIVER LICENSE OR CALIFORNIA ID CARD NUMBER (CRC] F.ONE) STATE ISSUED ARE YOU A COMBAT VETERAN?YES E]NO q SERVED IN WAR ZONE?YES q NO C]WHE HAVE YOU ATTENDED A PREVIOUS STAND DOWN?YES q NO q WHERE? ,WHEN? ARE YOU CURRENTLY HOMELESS? YES q ' NO q HOW LONG EL\VE YOU BEEN HOMELESS? / (MO/YR) HAVE YOU APPLIED FOR VA MEDICAL BENEFITS? YES q NO q OTHER VA BENEFITS? YES Q NO q CURRENT MEDICAL NEEDS: DENTALq HEARING q VISION q FEET q OTHER DO YOU HAVE PROBLEMS WITH ALCOHOLQ DRUGS q OTHER ADDICTION S CURRENT MENTAL HEALTH NEEDS : PTSD q SEA UAL TRAUMA q OTHER q HAVE YOU ENPERIENCED A TRoU\1ATIC BRAIN NUKE).:FBI)IN COMBAT?YES STAND .DOWN APPLICATION 201 2 MIDDLE MESSAGE TELEPHONE CURRENT LEGAL NEEDS : OUTSTANDING INFRACTIONS? YES q NO q REQUEST STAND DOWN COURT? YES q FORM MW I hl --'NED ON ItEVERSF 3 SANTA BARBAR A COIINVETERA N STAND INIIY N (105)to-ti 10 0 Date Receive d Veteran Status : CHILD SUPPORT CASE WITH DCSS? YES ~]NO q OTHER CHILD SUPPORT CASE S? YES q NO q LEGAL ADVICE? YES q NO q WILL YOUR LEGAL SPOUSE ACCOMI ANY YOU? YE S q NO q \A ILL YOUR CHILDREN UNDER AGE IS ACCOMPANY YOU? E S q NO q WILL Y011 HAVE \ PETS i AV1TH YOU T THE EVEN? l ES q NO q DOGE] C M q SIZE IN LEA : 2-20 q 21-50 q 51-SO q 80-100+E LIMITED TRANSPORTATION SPACE WILL BE AVAILABLE FOR . MUZZLED AND-OR CRATED ANI?.LALS STAND DOWN SHUTTLE ALL shuttles depart at 6 a.m. and return at 6 p.m.on Saturday, October 13,101 2 This section is for planning purposes only-transportation will not be guaranteed and will be on a limited first - come-first-served basis from the following locations : PLEASE INDICATE ONLY ONE PICKUPLOCATION CASA ESPERANZA'HOMELESS CENTE R 816 CACIQUE STREET SANTA BARBARA []SALVATION ARMY HOSPITALITY HOUS E S=TORAGE IS NOT AVAILABLE ) 423 CHAPALA STREE T,\N[ i,\ ft'vRhARA SAN LUIa L SPO \t \\INE LEWIS .NAEMORLAL SHELTE R -50CR .J.flll R.C\D h AN Ll 11 J hISP~` OSANTA MARIA SALVATION ARMY 402 SOUTH MILLER STREE T SANTA MARI A OGUAD.ALUPE AMERICAN LEGION POST 371 1025 GUADALUPE STREET GUADALUP E OSOLVANG VETERANS' ME .MORI .AL BUILDIN G 1745 MISSION DRIV E SOLVANG q LOMPOC VETERANS'HALL 100 EAST LOCUST AVENU E LOMPOC OWILL YOU NEED SAFE STORAGE FOR . YOUR BELONGINGS AT YOUR DEPARTURE . LOCATION ? APPLICATION DOES NOT GUARANTEE ENTRANCE TO STAND DOWN—YOU MUST BE A VETERA N RELEASE OP LIABILIT Y I, the undersigned, ,itknowledge that by signing this RELEASE OF LIABILITY, I will be giving up certain legal rights, and furthe r acknowledge that Santa Barbara County does not provide medical or accident insurance . In consideration of being permitted to participat e in Santa Barbara County Veteran Stand Down, hereinafter referred to as "the Program," the undersigned agrees to the following , The undersigned hereby releases, waives, discharges and covenants not to sue County, its employees, elected officials, representatives , attorneys officers, agents, and contracted entities (hereinafter referred to as "Releasees") from any and all lossee, damages, claims, actions , losses, demands, causes of action, liabilities, obligations, injuries, judgments, payments of every kind and character, known or unknown , existing or contingent, latent or patent, relating to or arising out of my participation in the Program, my use of any property, facilities,o r equipment in connection with the Program, whether caused in whole or in part by any negligent act or omission of the Releasees o r otherwise . The undersigned hereby agrees to indemnify and hold harmless the Releasees from all liabilities,claims,demands,causes of action , judgments, charges, payments costs, espenses,and attorney's tees relating to or arising out of participation in the Program, use of any property, facilities, or equipment in connection with the Program, the Video-Photo Release set forth below, or any decision to consent to or refuse medical, dental, or other tittered care Or service,whether caused in whole or in part by any negligent act or omission of the Releasee s or otherwise . The undersigned represents that he or she has knowledge and notice of, is familiar with, and understands the risks associated wit h participating in the Program and using property, facilities, and equipment in connection with the Program, including, but not limited to, ris k of bodily inlury, death, damage, and other injury and loss of property, The undersigned knowingly and freely hereby assumes ful l responsibility for :and the risks of all bodily injury, death and other loss, including, but not limited to, property damage relating to or arisin g out of participation in the Program or using any property, facilities, or equipment in connection with the Program, whether caused in whol e or in part by any negligent act or omission of Releasees or otherwise . The undersigned expressly agrees that this RELEASE OF LIABILITY, and VIDEQ-PHOTO RELEASE, are intended to be as broad an d inclusive as permitted by California law . I hereby affh•m that 1 h,me read, understand, and voluntarily agree to all terms and conditions contained herein . VIDEO-PHOTO RELEAS E I give the County of Santa Barbara and its employees, elected officials, representatives, attorneys, officers, and agents, an ci contracted entitie s ("County") permission to make photographs, videotapes, films or other likenesses of me . I hereby grant to County the unrestricted right t o copyright any of the those mentioned materials containing images of me,as well as the unrestricted right to use and reuse them, with thei r caption information, in whole or in part, in any manner, for any purpose and in any medium now known or hereinafter invented . Thes e rights include, but are not limited to, the right to publish, copy,distribute, alter, license and publicly display these materials and images fo r editorial, trade, nrn he ting mid for advertising purposes . I understand and agree that I will not be paid for any use of any photographs , videotapes, films, or other likenesses of me, including, but not limited to, the uses described above . I also waive, and release and discharge the County from, any and all claims related to, arising out of, or in connection with any use of th e enter i ris, captior, information and images described above, including, but not limited to, any and all claims for libel, defamation and/o rinvasion of pris icy or publicity . I understand and agree that I cannot withdraw my consent after I sign this form and that this form i sbinding on me and my agents, assigns, heirs, and next of kin . SIGNATURE DATE