By signing this form you grants Stripes and Pieces Foundation permission to use photographs, video recordings, or testimonials of individuals served by or involved with the organization to promote its mission, raise awareness, and communicate its impact through various media platforms.
* Confidentiality Statement
The Stripes and Pieces Foundation is committed to protecting the privacy and confidentially of all individuals who seek assistance. In accordance with applicable laws of the State of Michigan and Federal Regulations, including but not limited to the Michigan Identity Theft Protection Act (MCL 445.61-445.79) and Privacy Act, the following confidentiality policies apply:
1. Protection of Information
Any personal, financial, or medical information provided to the Stripes and Pieces Foundation will be treated as confidential. This includes, but is not limited to: • Names • Addresses • Social Security Numbers • Financial Records • Health Infomration • Other Identifying or Sensitive Information
2. Authorized Access
Access to confidential information will be restricted to employees, volunteers, and third-party service providers who require such access to perform their duties and who have agreed to uphold this confidentiality policy.
3. Disclosure Limitations
Information will not be shared, disclosed, or distributed to unauthorized parties without the individual's written consent, except as required by law (e.g., court orders, subpoenas, mandated reporting, or law enforcement investigations).
4. Data Security
The Stripes and Pieces Foundation employs physical, electronic, and procedural safeguards to protect confidential information from unauthorized access, loss, or misuse.
5. Compliance and Accountability
All staff members, volunteers, and affiliates of the Foundation are required to sign and adhere to this confidentiality agreement. Violation of this policy may result in disciplinary action, including termination of employment, volunteer duties, or legal action.
6. Client Rights
Individuals have the right to: • Request access to their personal information • Correct inaccuracies in their records • Inquire about how their information is used
Acknowledgement of Confidentiality
By interacting with the Stripes and Pieces Foundation, individuals acknowledge their understanding of this confidentiality policy and agree to its terms. If you have any questions or concerns about this policy, please contact: Stripes and Pieces Foundation
