Confidentiality Agreement

I, First Name*   Last Name*, agree with the following statements: 

I have read and understand The Frederick Center’s Confidentiality Policy: 

Attendees participating in The Frederick Center activities and events must adhere to our Confidentiality Agreement. Information, including personal information about fellow attendees or center staff, will NOT be shared: 

• with friends, family members, or coworkers,
• on the internet, including social media sites,
• regarding names, conversations, or specific topics and discussions.

If a staff member is aware of a participant not following this agreement, they will report it to the Program Director, Executive Director, or a board member as soon as possible.  

In addition, The Frederick Center’s facilitators and staff follow therapist-patient confidentiality policies and are mandated reporters. All meetings and support groups are confidential unless a staff member is concerned for your safety and is required to report to a parent or guardian or other emergency contact, to Child Protective Services, or to another agency. Statements regarding self-harm, suicide, sexual or physical abuse, or other incident that legally requires a report or action, may result in such, to the discretion of the staff members informed

I understand that I may encounter confidential information while visiting The Frederick Center or attending The Frederick Center programming. As part of the condition of my participation in events with The Frederick Center, I hereby agree to maintain the confidentiality and privacy of other TFC clients, participants, or other attendees. I agree never to remove confidential information or material from The Frederick Center facility or events.  
 
I understand that violation of this agreement may result in the termination of my participation in The Frederick Center programming, events, or sponsored activities, at the discretion of TFC staff and the Board of Directors.