Random Drug & Tobacco Testing Form

Random Drug and Tobacco Testing Enrollment FORM

* Indicates required field

Child's Name *

I have read and understand the regulations of the Random Drug Testing (RDT) program. I consent that my child be enrolled in this program, hereby, voluntarily agreeing to be subject to its terms for my child's entire school career (grades 9-12). I accept the methods of obtaining necessary specimens, testing and analysis of specimens, and all other aspects of the program. I agree to cooperate in furnishing necessary specimens that may be required in accordance to the Random Drug Testing (RDT) program.

I further agree and consent to the disclosure of the sampling, testing and results provided for the RDT program. This consent is given pursuant to all State and Federal Privacy Statues and is a waiver of rights to nondisclosure of such test records and results only to the extent of the disclosures in the RDT program.

Finally, I additionally understand there are, and agree to accept, Center Grove Ultimate Club, Inc. (CGUC) based consequences of any failure to uphold the requirements of Center Grove High School's drug and tobacco related policies at any CGUC associated event (regardless of the event's time, location, or function) including but not limited to suspension or expulsion from the CGUC, as to be determined at the CGUC Board's discretion in accordance with the CGUC's bylaws.

Child's Electronic Signature *

Date (mm/dd/yyyy) *

Parent's/Legal Guardian's Electronic Signature *

Date (mm/dd/yyyy) *

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Random Drug and Tobacco Testing Enrollment FORM

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