Random Student Drug Testing Consent Form
PDF Version of Consent Form | Transcribed below:
CUERO INDEPENDENT SCHOOL DISTRICT Random Student Drug Testing Consent/Opt-Out Form
PRINT Student Name: Grade Level: Birthdate:
Please select ONE option below and sign in that section.
Option #1 – To Consent
As a student …
§ I have read the Cuero Independent School District’s Random Student Drug Testing Policy, and I understand and agree that participation in school-sponsored extracurricular or co-curricular activities is voluntary and a privilege, as is the opportunity to obtain a parking permit, and to have open-campus lunch.
§ I understand that as part of my voluntary participation in school-sponsored extracurricular or cocurricular activities, obtaining a parking permit, and having open-campus lunch, I hereby consent to undergo random drug testing for the presence of alcohol, illicit drugs and/or banned substances in accordance with Board Policy. I understand and agree that my consent shall be in effect unless and until revoked in writing.
§ I understand the collection process will be overseen by a qualified vendor and that confidentiality will be secured. I hereby consent to the vendor selected by the Cuero Independent School District, its laboratory, doctors, employees, and/or agents to perform testing for the detection of alcohol, illicit drugs and/or banned substances, and to confer with any necessary third parties regarding the results in order to confirm the results.
As a parent/guardian/custodian …
§ I have read the Cuero Independent School District’s Random Student Drug Testing Policy, and I understand and agree that my
child’s participation in school-sponsored extracurricular or co-curricular activities is voluntary and a privilege, as is the opportunity to obtain a parking permit, and to have open-campus lunch.
§ I understand that as part of my child’s voluntary participation in school-sponsored extracurricular or cocurricular activities, obtaining a parking permit, and having open-campus lunch, I hereby consent for my child to undergo random drug testing for the presence of alcohol, illicit drugs and/or banned substances in accordance with Board Policy. I understand and agree that my consent shall be in effect unless and until revoked in writing.
§ I understand the collection process will be overseen by a qualified vendor and that confidentiality will be secured. I hereby consent to the vendor selected by the Cuero Independent School District, its laboratory, doctors, employees, and/or agents to perform testing for the detection of alcohol, illicit drugs and/or banned substances, and to confer with any necessary third parties regarding the results in order to confirm the results.
PRINTED NAME Student SIGNATURE Student Date
PRINTED NAME Parent/Guardian/Custodian SIGNATURE Parent/Guardian/Custodian Date
Option #2 – To Opt Out
As a student …
§ I understand and agree that by opting out or declining to consent to participate in the Random Student Drug Testing Program, I will
be unable to partake in school-sponsored extracurricular or cocurricular activities, to obtain a parking permit, or to have open- campus lunch privileges.
As a parent/guardian/custodian …
§ I understand and agree that by declining to consent for my child to participate in the Random Student Drug Testing Program, my
child will be unable to partake in school-sponsored extracurricular or cocurricular activities, to obtain a parking permit, or to have open-campus lunch privileges.
PRINTED NAME Student SIGNATURE Student Date
PRINTED NAME Parent/Guardian/Custodian SIGNATURE Parent/Guardian/Custodian Date