Fillable Printable Consent to Participation in Mandatory Student Drug Testing Program Form

Consent to Participation in Mandatory Student Drug Testing Program Form

SEALY INDEPENDENT SCHOOL DISTRICT

Sealy High School

2372 Championship Dr. Phone: 979.885.3515

Sealy, TX 77474 www.sealyisd.com Fax: 979. 987.3398

Sealy ISD does not discriminate because of race, age, color, national origin, sex or disability.

Consent to Participation in

Mandatory Student Drug Testing Program

We have read and understand the policy governing Sealy ISD’s Mandatory Drug

Testing Program. We understand that as a condition of participation in

extracurricular programs and a condition for parking and driving on school

premises at Sealy High School, the student named below must participate in the

drug testing program. By our signatures below, we authorize Sealy ISD to

conduct drug testing on any urine specimen/breathalyzer testing that the named

student will provide on the dates and times specified by the Sealy ISD School

officials.

We understand that at the time of test, we, at our own discretion, may provide a

copy of any medical prescription or doctor’s verification related to any medicines

the student may be taking. If we provide this information in a sealed envelope to

school personnel, we understand that the sealed envelope will be forwarded

unopened to the designated testing lab. We further understand that the lab will

be instructed to consider the student’s use of such medication to assure an

accurate outcome of the drug testing. The prescription drug information will not

be disclosed by the testing lab to any SISD school official.

________________________________ Male □ Female □

Student Name:

________________________________

Student ID#:

______________________________________ _______________

Signature of Parent/Guardian: Date

______________________________________ _______________

Signature of Student: Date