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275 Community Partner Application Confirmation
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Frederick County Senior Services - Volunteer Agreement

  1. The Frederick County Senior Services Division upholds the right to privacy, respect, and confidentiality of all citizens who use the services of this agency. In addition, all information heard or seen while acting as a volunteer representative of the Senior Services Division; whether in a private home, department facility, or other location shall be considered confidential. Such information shall only be shared or discussed with those individuals having direct involvement with a particular client or situation, and when the client or his/her Power of Attorney has granted permission to do so.

    I have read and understand the Senior Services Division Privacy, Respect, and Confidentiality Agreement. I agree to maintain and support the Privacy, Respect, and Confidentiality of the Frederick County Senior Services Division. The Senior Services Division accepts the service of all volunteers with the understanding that such service is at the sole discretion of the Senior Services Division. Volunteers agree that the Senior Services Division may decide to terminate the volunteer’s relationship with the Senior Services Division or make changes in the nature of the volunteer assignment at any time.
  2. I have received a copy of this statement.
  3. First and Last Name
  4. xx/xx/xxxx
  5. Leave This Blank:

  6. This field is not part of the form submission.