Sample Confidentiality Agreement Template


Individual Council logo
to be added here
Name of Local Council_____________
Print Name
The protection of confidential information both past and present is vital and necessary to
the interests and success of the Name of Council. Confidential information includes, but
is not limited to the following examples:
Client names and personal information
Whether or not the client is receiving services
All client file information
All personal staff or volunteer personal information
Donor names or information
Financial information
Computer programs, codes and data
Other information and data communicated as confidential
Also, it is expected that volunteers will not initiate any council related communications
with those served by the local council or their family members when encountered in
public places nor acknowledge your familiarity with them.
This organization’s confidentiality policy is compatible with and in accordance with all
federal and state related statutes and other professional ethics and standards. If you are
uncertain about whether information is confidential, check with your volunteer
coordinator before discussing it with anyone. All volunteers are required to adhere to
this policy.
Improper use or disclosure of confidential information may result in
disciplinary action, up to and including termination of volunteer status and//or
appropriate legal action.
I acknowledge the Council's policy regarding confidentiality and agree to abide by and
understand the consequences of improper use or disclosure of confidential information.
Volunteer Signature
Personnel Signature
CTF and/or other logos placed across bottom of sheet


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