Subject: Ethical Practice COA: ETH 3 Applies to: All Catholic Charities volunteers

Group Volunteer Confidentiality Agreement Form Number: 1011-58 Effective: 01/09/2008 Revision effective: Reviewed:

As a volunteer I agree to protect the right to privacy of clients, staff members, and other volunteers who work for or with Catholic Charities, diocese of Fort Worth. During my volunteering time, I will limit my discussion about clients to that, which is necessary to carry out my volunteer duties. I will not discuss or share information about clients or the services they received with any one outside of Catholic Charities without the direct approval of the Program Coordinator or Department Director. I will not take photographs of clients, staff members, or other volunteers without the written consent of the Program Coordinator or Department Director and the subject to be photographed. I understand that children in the custody of the Texas Department of Protective and Regulatory Services may not be photographed. I have read and agree to abide by this agreement, and I understand that I can be released as a volunteer from Catholic Charities, Diocese of Fort Worth, Inc. should I violate any of these conditions. Date: _____________________ Name of Group: ________________________________

Contact Person: ______________________________________________________________ Phone Number: ______________________________________________________________ Address: ____________________________________________________________________ Catholic Charities Program: ___________________________________________________ Activity: _____________________________________________________________________ Length of Activity: ____________________ Number of Volunteers: _______________

Signatures: Please sign the back of this form indicating you understand the above Statements. All volunteers must sign this form.