Belton ISD Student Drug Testing

Belton ISDStudentDrugTesting Consent Form

2016-2017

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Student Last NameStudent First NameStudent ID #Grade Level

AS ASTUDENT:

Iunderstandand agreethatparticipation inschool-sponsoredextracurricularactivitiesisvoluntaryanda privilege. Iunderstandthatas partof myvoluntaryparticipation inschool-sponsoredextracurricularactivities, IamconsentingtoparticipationintheBISD’s RandomStudentDrugTestingprogram. The listofschool-sponsoredextracurricularactivitiescan beaccessedon theBISD website( byfollowingthe links to DistrictPolicies,FNFLOCAL.

Iunderstandthatif Idecline to consentto participationin theRandomStudentDrugTestingprogramthatIwillbeunabletoparticipateincompetitiveextracurricularactivities in BISDfor the entireacademic schoolyear,2016-2017.

AS APARENT/GUARDIAN/CUSTODIAN:

Ihave read BoardPolicyFNF(LOCAL) and understandthatmychild’sparticipationinschool-sponsoredextracurricularactivities andenrollmentincorrespondingcoursesis voluntaryand aprivilege. Iunderstand thatas partofmychild’svoluntaryparticipationinschool-sponsoredextracurricular activities, Iamconsentingto his/herparticipationin BISD’sRandomStudentDrugTestingprogramfor the entire academic schoolyear,2016-2017. The parent and student drug testing program presentation can be reviewed on the BISD website at the following link (

Iunderstandthatif Idecline to consentto mychild’sparticipation inthe RandomStudentDrugTestingprogram,mychild willbe unable toparticipatein school-sponsoredextracurricularactivities.

Asevidenced bymysignaturebelow, Iherebyconsent to allowthestudentnamedabove to undergorandomdrugtestingforthepresenceofillicitdrugsand/orbannedsubstances inaccordancewithBoardPolicyFNF(LOCAL). Iunderstandthatthe urinecollectionprocesswillbe overseen bya qualifiedvendorandthatsampleswillbesentto acertifiedmedicallaboratoryfortesting,andthatsampleswillbecodedforconfidentiality.Iherebyconsenttothevendorselected bythe BISD, itslaboratory,doctors,employees,and/oragentstoperformurinalysistestingforthedetectionofillicitdrugsand/orbannedsubstances,and toconfer withanynecessarythirdpartiesregardingtheresultsin ordertoconfirmtheresults ofthe urinalysis. Ifurtherunderstandandconsentto thevendorselectedbyBISD, its doctors,employees and/or agents, toreleaseresults ofteststothe BISDinaccordancewithBoard PolicyFNF (LOCAL). Iunderstandthattheconsent grantedhereinis effectivefor the entire 2016-17 schoolyear.

PRINTEDNAMEParent/Guardian/CustodianDaytime phone number

SIGNATUREParent/Guardian/CustodianDate

STUDENT SIGNATUREDate

Rev.July 2016