As an unpaid volunteer, my signature below signifies my understanding that all patient information is treated with utmost confidentiality out of respect for the patient and for legal and ethical reasons. My signature further signifies my understanding that, many of the communications between Alabama Free Clinic and its patients are protected by law as privileged or otherwise confidential, and information is highly confidential for this reason. Thus, as a condition of service as a volunteer for AFC, you are required not to 1) Misappropriate 2) Disclose to any third party, either directly or indirectly or aid anyone else in disclosing to any
third party, either directly or indirectly, all or any part of any AFC confidential information. All volunteers are required to maintain strict confidentiality at all times concerning any confidential
information to which they may be privy. Accordingly, it shall be the right of AFC to discipline or terminate any volunteer who breeches such confidentiality. My signature below signifies that I will abide by the conditions of this confidentiality policy.
I understand and agree that submitting this application form does not automatically register me as an Alabama Free Clinic volunteer, and that there may be certain qualifications I must meet,
including the acceptance of established volunteer policies and procedures before I may begin volunteering.
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application or interview may result in my release from volunteering.
I understand some jobs require a background and license check. I understand that this may be requested depending on my job assignment. By submitting this form and by signing my name on the signature line, I agree all of the information is accurate and true.