1 Safe Sleeping Village Community Participant Agreement
The Safe Sleeping Village (SSV) is managed and operated by Urban Alchemy (UA). As a condition of participation in the program, you agree to the terms and conditions in this Program Agreement. This agreement is fully enforceable in the event of a transfer in management from the operator to other non-profit partner agencies and may require you to sign additional agreements.
The purpose of this Safe Sleeping Village is to:
Provide temporary safe sleeping areas and respite to unsheltered adults living in the area.
Eligibility Criteria
The SSV is a voluntary program offered to unsheltered Culver City residents. To ensure compliance with the federal Centers for Disease Control and Prevention’s (CDC) best safety practices for COVID-19, initial spots will be offered to individuals in the immediate area to minimize the movement of people throughout the city.
Expectations
As a participant, you can expect:
● A safe environment where staff and participants mutually support respectfulness, safety, cleanliness, and peaceful working through disagreements may arise. ● To complete an HMIS intake.
● To develop an exit plan for where you would like to be in the future, as Safe Sleeping Sites are not permanent.
You are required to adhere to the “Code of Conduct and Safe Living Expectations for Safe Sleeping Villages” document.
Entrance to the Program
To enter the program, you must agree to comply with the Code of Conduct. Once you agree to comply and are accepted into the program, you will be assigned a designated space within the Safe Sleeping Village. Additionally, site staff will record the necessary information about you (Name, DOB, Gender) and a description of your tent.
All tents will be given a unique identification number and designated spot in the SSV.
Intakes into the SSV will occur between 9 am and 5 pm daily.
2 Length of Stay
The Safe Sleeping Village at the Fulton Mall is a temporary program designed to provide a safe, clean environment to unsheltered individuals in the area. If participants comply with the Code of Conduct, they are welcome to stay for the entire length of the program but are encouraged to take other alternative housing opportunities if they become available. In addition, the city may terminate or extend the program at any time.
You understand that this program creates no right or interest enforceable under California or Culver City landlord tenant laws. The operator of the SSV may terminate or extend a participant’s ability to enter or remain on the premises at any time and for any reason, at the operator’s sole discretion. The non-profit operator reserves the right to go near all assigned occupied areas for security, inspection, maintenance, or any other reason the operator deems necessary.
Visitor Policy
● For safety reasons, visitors from outside of the SSV will not be permitted to enter. ● If participants at the SSV want to visit with each other, they should do so in open spaces.
People should always maintain at least 6 feet of physical distance and use appropriate facial coverings or masks. In general, participants are encouraged to socialize with as few people as possible and ensure it is the same, small group of people.
Pet Policy
● Participants are permitted to enter the SSV with pets but cannot acquire new animals during their stay.
● All pets must be with owners at all times and cannot roam throughout the area unattended.
● Participants must clean up after their pets.
Health and Safety
● The SSV staff make the best efforts to provide a safe and healthy environment.
However, the operator is not liable for any lost, stolen, or destroyed property at the site. ● Personal belongings must remain in their assigned space unless otherwise directed by the site operator.
● Participants must be fully dressed at any time while in the shelter open and common areas.
● For your safety and hygiene, shoes must be worn when outside your tent. ● Waste and garbage must be disposed of in the site trash can receptacles.
3 ● No weapons or contraband, or objects that could be construed as such, are permitted under any conditions. Possession of any weapon or objects that could be deemed a weapon (including but not limited to firearms and pocketknives) may result in immediate discharge.
● No open flames are allowed anywhere in the SSV.
● Smoking is only permitted in designated smoking areas. ● No open-air drug sales on the premises.
Emergency Situations
In case of an emergency, please contact the staff or call 911 for assistance.
Reasons for Program Discharge
Participants are expected to follow the Code of Conduct. Failure to do so may result in discharge from the program.
Confidentiality
All participants have the right to have their personal and private information kept confidential.
Therefore, the staff is committed to keeping your participant information confidential to the full extent permitted by law. If you wish for us to share confidential information about you with anyone outside of the program, you will need to sign a written Release of Information form before we will release the requested confidential information.
By law, there are a few exceptions to confidentiality that allow for the disclosure of information without our consent. These exceptions are as follows:
● If there is a reasonable suspicion of abuse or neglect towards a child. ● If there is a reasonable suspicion of the abuse or neglect of an elder adult (age 65 or over) or of a dependent adult (someone who is not capable of caring for themselves) ● If an occupant presents a danger to self.
● If an occupant presents a danger to others.
● In the case of a medical emergency for purposes of obtaining medical treatment. ● If a court subpoenas your records.
4 Acknowledgment of Receipt
● By signing below, I acknowledge that I have reviewed this Program Agreement, and I agree to the terms set forth herein.
● I further acknowledge that I have discussed and understand what is required of me at this SSV and that I agree to genuinely engage the support staff in ending my unsheltered status.
● I understand that if I do not remain in compliance with these agreements, I may be asked to leave the SSV. I understand that the operator, in its sole discretion, may provide me with the opportunity to discuss the situation before being asked to leave the program. ● I understand that my participation in the program is at the discretion of the operator. ● I understand that I may forfeit my opportunity to participate in this program if I violate any of the terms of this agreement.
● I understand that this is not a rental agreement. I understand that the shelter site is an interim short-term program. Nothing in this agreement, whether expressed or implied, creates a landlord-tenant relationship between the Program or Operator and any participant.
● I further understand that my participation at the shelter site does not entitle me to any rights, benefits, or privileges under the California Relocation Assistance Law, or under any similar law, if my participation ends for any reason, whether voluntarily or involuntarily.
Participant Name (Print): _________________________________________________________
Signature: __________________________________________________Date: ______________
Partner Name if sharing Tent Space: ________________________________________________
DOB: ____________ Last 4 SSN: ____________ Agrees to Pursue Coordinated Entry: Y/N
Gender: Male/Female/Non-Binary/Prefer Not to Say/ Other(please specify)______________
Site Operator Intake Staff Name (Print): _____________________________________________
Signature:_________________________________________________Date:________________
Tent Space Assignment #________________