Sample Confidentiality Agreement

(Excerpted from The ACCESS Mentor Training Manual. Used with permission from the GRACE AIDS Care Network, Grand Rapids, Michigan.)

Confidentiality is the cornerstone of a trusting relationship between a volunteer and a client. As a mentor/volunteer, I will have access to personal information concerning a client, which should be held with the highest regard. Therefore, I agree never to release the name, address, phone number or any other information that may identify the client to anyone except the volunteer program staff, unless authorized by the client.

A breach of confidentiality may consist of:
·        talking about a client, by full name, with your family or friends
·        talking about a client with his/her family without the client's permission
·        telling anyone other than the volunteer program staff the name of your client unless authorized by the client.

I have read and understand the above confidentiality statement and hereby agree to abide by this rule.

Mentor/Volunteer Signature:
Date: