Volunteer Confidentiality Agreement for Couples Counseling and Psychotherapy Associates

For the purposes of this Agreement, Couples Counseling and Psychotherapy Associates is hereafter referred to as the
“practice”

“I” refers to the volunteer who signs this Agreement

1. I acknowledge and confirm that as a volunteer I may acquire information on the therapy practice, its clients, staff and volunteers, and about certain matters and things which
are of a confidential nature and that such information is the exclusive property of the practice and will remain in the strictest confidence.

2. I affirm that the information referred to above could be used to the detriment of the practice, clients, and the volunteer activities and thereby undertake to treat as confidential all information, contracts or resources. I agree not to disclose the same to any third party either during the term I am volunteering for the practice or at any time thereafter unless required by law to do so or have obtained the express written permission to do so from a member of the practice.

3. I agree that any knowledge gained as a result of my position will remain in strictest confidence.

4. I agree to exercise due care to ensure that any information I may give to others in the course of my duties as a volunteer or otherwise is information that is required to be given and is given to a party entitled to receive such information.

5. I agree I will not discuss the details of my volunteer work with any representatives of the media or to publicize any of the confidential aspects of my work orally or by written work or any other medium of communication unless express written permission is given by a member of the practice.

This form is directed to volunteers that are not Certified Gottman Therapists and those that did not receive Roving Therapist Training from the Gottman Institute.

As a volunteer, I am permitted to:

1. Assist with administrative roles, including but not limited to: workshop set-up and clean-up, registration, directing workshop participants to bathrooms and food sources, workshop food coordination, display of workshop materials and time keeping.
2. Assist with role-play presentations and participate as an actor/actress.

As a volunteer, I am NOT permitted to:

1. Interact personally with the workshop participants or offer personal advice in any way, outside of administrative responsibilities.
2. I understand that all information I learn about or overhear about an individual or couple attending the workshop, which includes financial, private or information of a sensitive nature, is considered confidential.  This information may not be disclosed to friends, family members or other co-workers or employees without a legitimate need to know.  Even the fact that a client is attending should not be information that is shared with others.  The unauthorized disclosure of confidential information can subject an individual and the workshop presenters to liability.

I hereby acknowledge, by my signature below, that I understand the actions that I am permitted and not permitted to do, and I understand and accept this confidentiality agreement.