Confidentiality Form

ALL KNOWLEDGE THAT YOU RECEIVE FROM NA HOALOHA REGARDING YOUR PARTICIPANT MUST BE KEPT IN THE UTMOST CONFIDENCE.
 
The individuals you will be working with deserve the respect and dignity of having their personal affairs kept confidential, just as you would like yours to be.
 
As you spend time with your participant, a bond of trust develops and many personal feelings and experiences may be discussed. There may be strong feelings toward family members or formal helpers, and the volunteer may be the only person available with whom to share these feelings. Maintaining that bond of trust is important in continuing an effective relationship. However, as a volunteer, you do have the responsibility to alert and discuss with Na Hoaloha staff any situation that endangers the health, safety, or welfare of the individual.
 
Please remember that you should not disclose information about your participant to those not directly involved with the person; such as your family, friends, co-workers, or others. NEVER GOSSIP! Many frail elders and people with disabilities are physically and emotionally vulnerable. A network of people and services enables them to remain in their own homes, but often at a price – the loss of control over once private matters. As a volunteer and a friend, you can help them maintain some control over their life by respecting their right to share confidences without fear of them being passed on to other people.
 
By signing below I, (Your Name) have read, understand, and will follow the above policy.
 

Your Email (required)

By checking this box and typing my name above, I am electronically signing this release form. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
I consent to my submitted data being collected and stored.

(NOTE: These checkboxes MUST be checked in order to submit the form.)