BRP Confidentiality Agreement

As a volunteer with Blacksburg Refugee Partnership, you are required to conform to all applicable laws and BRP policies governing confidential information. Simply by being with the families, you may encounter confidential information. Care is often coordinated in semi-public environments where there is the risk that a family member’s information may be heard or viewed by individuals not directly involved in the family’s care. BRP has policies intended to limit the risks of such incidental disclosures of information.

Any information you see or hear regarding the families, either incidentally or by attending appointments, must be kept confidential. By signing below, you are agreeing to abide by BRP policies regarding confidentiality.

As a condition of and in consideration of, my use, access, and/or disclosure of confidential information, I First Name* Last Name* understand and agree to the following:

I will access, use, and disclose confidential information only as permitted by BRP policy. This means that I will only access, use, and disclose confidential information that I have been given authorization to access, use, and disclose by the family members.
I understand that any fraudulent application, violation of confidentiality or any violation of the above provisions will result in the termination of volunteer status with BRP.
My signature below indicates that I accept and agree to abide by all of the terms and conditions of this Agreement and agree to be bound by it.

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