Kenora Association for Community Living

501 Eighth Avenue South

Kenora, Ontario

P9N 3ZP

Agreement to preserve confidential information

I, _________________________, undertake to respect the confidential nature of the work of the Kenora Association for Community Living (KACL).

I agree not to divulge to others in the community, nor to discuss with anyone who does not require to know, any information which I may become aware of, involving the Association's work.

I also agree not to obtain or release information that might in any way considered confidential, without first obtaining written authorization from the consumer or/his legal representative to do so.

___________                                                                ____________

Witness                                                                          Signature

Date:________________