Parent Confidentiality Statement

Parent Confidentiality Statements
Parent/Guardian Name: *

First Name Last Name
Behaven Kids makes sure that all information about the children enrolled an other family information is kept confidential. This helps to ensure the privacy of all families and their children. Please help us keep information confidential by agreeing to the following:
I, parent/guardian, agree to keep confidential any and all information about other children and families while my child is enrolled at Behaven Kids. *
Electronic Signature
I undestand that this confidentiality statement includes not using other children's or families names or any other information which could identify them when discussing the Behaven Kids program in any public meeting place.

I understand that, should I violate this policy, my child may be discharged from the program.
Child's Name: *

First Name Last Name
Electronic Signature of parent/guardian: *
Date *

Month Day Year
Date
Should be Empty:

Parent Confidentiality Statements