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Drug Testing Consent Form
6/21/2012

CONSENT TO PERFORM URINALYSIS FOR DRUG TESTING  

I hereby consent to have a sample of my urine collected and tested for the presence of drugs in accordance with the Bedford County Board of Education Drug and Alcohol Education and Testing Policy.  

I understand that this testing will occur at such time or times as deemed appropriate by school officials.  I also understand that any urine samples collected will be sent only to a licensed medical laboratory for actual testing and that the testing procedures will maintain the confidentiality of the results.

I hereby authorize the release of such urine testing results to the principal, athletic director, head coach, certified athletic trainer and/or team physician, and other school officials necessary for the implementation of the Drug and Alcohol Education and Testing Policy and Procedures.  I understand that the results will also be made available to me.  I also authorize, upon their specific request, the release of the results of such tests to my parents(s)/guardian(s).  

I understand that I am free to withdraw this consent for urinalysis testing; however, I also understand that should I refuse to submit to testing at any time requested by school officials, I will not be permitted to participate in any school athletic, cheerleading, or extra-curricular program until such time as the principal, athletic director, head coach, or other school official shall deem appropriate.  

I hereby release Community School and the Bedford County Board of Education from any legal responsibility or liability for the release of such information and records as authorized by this form.

 

Signature of Student_______________________________ Date__________

 


Signature of Parent/Guardian________________________ Date__________