Faith Strong Angel Confidentiality Agreement Form

Faith Strong Angel Confidentiality Agreement Form
Name*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IInsert your first and last name*, agree to serve as a 2023 Faith Strong Angel which requires me to make a monthly commitment to a breast cancer thriver or metativor beginning January 2023 and ending December 2023.

In addition, I:

Initial* agree to keep my assigned person’s name, mailing address, birthday, and any other personally identifiable information, including health information, confidential unless an individual or organization is assisting me with my monthly commitment.

Initial* agree to never reveal or make known my name or any of my contact information. I am to remain anonymous throughout the twelve months duration.

Initial*agree to not express any political views when making my monthly contact.

Initial* agree that my service and contributions are voluntary and that I will not be refunded, compensated, or owed for any costs I incur or time I expend as a 2023 Faith Angel.
Insert Your Name*
Please Sign*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
To inform Faith Strong of any desired restrictions or to make changes at any time, email us at info@wearefaithstrong.com or mail your request to

Faith Strong, Inc.

PO Box 3398, Sumter, SC 29151-3398
Should be Empty: