Sir Winston Churchill Secondary School
LEADERSHIP AND PEER SUPPORT PROGRAM (LPS)
CONFIDENTIALITY STATEMENT

I, the undersigned, promise to hold in confidence all matters that come to my attention in my role as a student in the LPS program, while place in:

________________________________ with _______________________________
(Course Code & Period)   (Name of Subject Teacher)

This includes material from and about students (i.e. regarding evaluation, progress, behaviour, achievement, personal matters, etc.), matters regarding teachers, other LPS Students or the administration and any other confidential information regarding Sir Winston Churchill Secondary School. I will respect the privacy of the people whom I assist and serve and I will confer appropriately with my supervisors. I will use any information gained in the course of my service with:

_____________________________________

 in a responsible manner.
(Name of Subject Teacher)  

Student Signature: ____________________________________________

Date: _____________________________________________________

Name of LPS Administrator: ____________________________________

Name of Subject Teacher: ______________________________________

Parent Signature: ______________________________________