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Confidentiality Agreement Sample 3

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Confidentiality Agreement Sample 3
Confidentiality Agreement Sample 3
[Insert Name of Organization
Phone/Fax #s
General Information Email Address
Web Address]
Sample Confidentiality Agreement
[Insert Name of Organization]
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
Signature of Staff Witness
Confidentiality Agreement Sample 3