Family Intake & Shelter Request Form

Welcome to AZ Hugs! We are here to help keep your family safe and cool during the extreme heat. Please fill out the intake form below so we can understand your situation and check availability for our overnight respite program.

Primary Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Household & Demographic

Number of Adults in Household

Number of Children in Household

Ages of Children

Zip Code of Last Permanent Housing

Are you currently experiencing domestic violence, an unsafe living situation, or pressure/threats from someone controlling your housing, money, or ID?

Yes

Prefer not to answer

Other

Are you or a family member currently seeking support for medical stabilization, detox, or substance use recovery?

Yes, seeking immediate treatment or detox placement

Yes, currently in recovery and looking for ongoing support

No / Not applicable

Prefer not to answer

Other

Which best describes your current living situation.

Unsheltered & Public Spaces

Outdoors (Street, sidewalk, alley, or vacant lot)

Public Park, trail, or wooded area

Abandoned building, squat, or construction site

Bus stop, train station, or transit facility

Vehicles & Temporary Transit

Car, truck, or van

Recreational Vehicle (RV) or camper

Public transportation (bus, train, etc.)

Temporary / Doubled Up (Friends & Family)

Staying with friends or family temporarily ("couch-surfing")

Sharing housing due to loss of housing, economic hardship, or similar reason (doubled up)

Temporary Paid Lodging

Motel or hotel paid out of pocket (without voucher)

Motel or hotel paid via emergency voucher / charitable assistance

Emergency & Transitional Housing

Emergency shelter

Transitional housing program

Other

Shelter Status & Waiting Lists

Are you currently on a waiting list for any other local shelters or transitional housing programs?

Yes

Immediate Relief & Support Needs

What types of immediate emergency assistance are you currently seeking? (Check all that apply)

Emergency Financial Need Amount for Tonight

Please describe any specific or urgent needs your family is facing right now.

Thank you for sharing this with us.

Your privacy is very important to us. Your family's information is private and used only by the AZ Hugs team to help connect you with resources. We never sell or share your personal data.

Because help across the Valley is very limited and wait lists can be long, we might not be able to reach every family right away.

But everything you shared is important. It helps us guide your next steps when help opens up, and it helps us show the community what families need so we can fight for better resources. Change takes time, but we are proud to stand with you and your children.

What happens next:

Please look out for your phone or check your email for updates from us.
If this is a real emergency, please call 911 right away.
If you haven’t already, please call 211 to connect with local community help.
Never stay anywhere you do not feel comfortable or safe. Your family's safety always comes first.

Primary Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Household & Demographic

Number of Adults in Household

Number of Children in Household

Zip Code of Last Permanent Housing

Are you currently experiencing domestic violence, an unsafe living situation, or pressure/threats from someone controlling your housing, money, or ID?

Yes

Prefer not to answer

Other

Are you or a family member currently seeking support for medical stabilization, detox, or substance use recovery?

Yes, seeking immediate treatment or detox placement

Yes, currently in recovery and looking for ongoing support

No / Not applicable

Prefer not to answer

Other

Which best describes your current living situation.

Unsheltered & Public Spaces

Outdoors (Street, sidewalk, alley, or vacant lot)

Public Park, trail, or wooded area

Abandoned building, squat, or construction site

Bus stop, train station, or transit facility

Vehicles & Temporary Transit

Car, truck, or van

Recreational Vehicle (RV) or camper

Public transportation (bus, train, etc.)

Temporary / Doubled Up (Friends & Family)

Staying with friends or family temporarily ("couch-surfing")

Sharing housing due to loss of housing, economic hardship, or similar reason (doubled up)

Temporary Paid Lodging

Motel or hotel paid out of pocket (without voucher)

Motel or hotel paid via emergency voucher / charitable assistance

Emergency & Transitional Housing

Emergency shelter

Transitional housing program

Other

Shelter Status & Waiting Lists

Are you currently on a waiting list for any other local shelters or transitional housing programs?

Yes

Immediate Relief & Support Needs

What types of immediate emergency assistance are you currently seeking? (Check all that apply)

Emergency Financial Need Amount for Tonight

Please describe any specific or urgent needs your family is facing right now.

Thank you for sharing this with us.

Your privacy is very important to us. Your family's information is private and used only by the AZ Hugs team to help connect you with resources. We never sell or share your personal data.

Because help across the Valley is very limited and wait lists can be long, we might not be able to reach every family right away.

What happens next:

Please look out for your phone or check your email for updates from us.
If this is a real emergency, please call 911 right away.
If you haven’t already, please call 211 to connect with local community help.
Never stay anywhere you do not feel comfortable or safe. Your family's safety always comes first.