PelotonU Participant Notice of Rights/Confidentiality Agreement

Your privacy is crucial to us. PelotonU realizes you confide in our ability to maintain the privacy and confidentiality of your personal information while providing exceptional services. Please review the following Participant Notice of Rights and Confidentiality Agreement.

 

As a participant of PelotonU, you have the following rights regarding the confidentiality of your personal information and communications with PelotonU staff and volunteers:

 

  1. The information that you provide to PelotonU, including your name, address, phone number, and other personal information will not be shared with other individuals or organizations without your permission.
  2. Some general information about the types of services provided and overall demographics (e.g., age and income ranges, average number of children, ethnicities) of people that participate in PelotonU must be shared with the agencies that fund PelotonU. However, information that specifically could identify you as someone who participates in PelotonU will never be shared unless authorized by you.
  3. In the event that you were referred to PelotonU by a partner organization or employer, you agree to allow PelotonU to share relevant information about your participation with the partner organization. You will be told, in general, what each partner’s obligations are to keep your information confidential. If you wish to not have your information shared with a partner organization, let a PelotonU staff member know. If you choose to have PelotonU share some of your personal information with an agency we partner with, you will be told exactly how and what information will be shared. If you later decide that you don’t want the information you have provided to be shared with any of PelotonU’s partners, let us know and we won’t share any more information with those partners.
  4. PelotonU staff may be required by law to report certain situations even if you don’t give them permission to share or report the situations, such as suspected child abuse or neglect. This includes but is not limited to threats to self or others, elder or at-risk adult abuse, child abuse, commission of a crime or a civil claim against PelotonU participants or staff. Staff will inform you of any reporting requirements prior to having conversations with you and will tell you when they must make a report and what information will be shared. Even when these reports are made, PelotonU should not share information beyond what is required by law.
  5. If you have any questions or concerns about this notice or your rights, or if you have a concern that your confidential information was not treated appropriately, please contact Lacey Pittman Tomanek, Executive Director at 214-636-7576 or lacey@pelotonu.org.
By signing below, I have received and read this notice of my rights to confidentiality as a participate in PelotonU's program.