Fillable Printable Sample Confidentiality Agreement

Sample Confidentiality Agreement

[Insert Name of Organization

Address

Phone/Fax #s

General Information Email Address

Web Address]

Sample Confidentiality Agreement

[Insert Name of Organization]

PLEDGE OF CONFIDENTIALITY

This is to certify that I, ______________________________, an employee, student, volunteer or Board member

of [Organization], understand that any information (written, verbal or other form) obtained during the

performance of my duties must remain confidential. This includes all information about members, clients,

families, employees and other associate organizations, as well as any other information otherwise marked or

known to be confidential.

I understand that any unauthorized release or carelessness in the handling of this confidential information is

considered a breach of the duty to maintain confidentiality.

I further understand that any breach of the duty to maintain confidentiality could be grounds for immediate

dismissal and/or possible liability in any legal action arising from such breach.

_______________________________________________

Signature of Employee/Student/Volunteer

_______________________________________________

Date

_______________________________________________

Signature of Staff Witness