I understand that information obtained during the course of service is privileged and confidential and may not be released without my written consent, except in the following situations:
- When it is necessary to disclose the information to the personnel of S.U.C.C.E.S.S., funder, regulatory body or accreditation agency who are authorized to receive such information in the course of their duties;
- When it is required by law or by an order of court; and
- When there is reasonable ground to believe that such release will prevent me from harming myself or other people, or being harmed.
All records are the confidential property of S.U.C.C.E.S.S. and are retained in a secure and protected environment which can only be accessed by key personnel. S.U.C.C.E.S.S. is in compliance with the Personal Information Protection and Electronic Documents Act (PIPEDA). All data collected from you is used only to: assist our worker in providing service for you; identify you as an eligible client; provide anonymous general statistics to related funders and in presentation to the public; as well as to help conduct general analysis for quality assurance.
I understand that if I have any concerns regarding the program or staff, I can contact the staff-in-charge.
I hereby give my permission to S.U.C.C.E.S.S. to use photos, a facsimile thereof or electronic image(s) in which I appear during the program. These photos or facsimiles may be reproduced by S.U.C.C.E.S.S. in print materials such as brochures and news articles. Electronic image(s) may be used in media such as the S.U.C.C.E.S.S.S. website, television news items or a video production.
I have read and understood the above agreement and agree to abide by the information herein.