Berry College Athletic Department

BCSMD 2013-2014 Form #5

BERRY COLLEGE ATHLETIC DEPARTMENT

Consent to Athlete Drug Testing

I understand that submission to testing for the presence of drugs is a condition of participation in intercollegiate athletics at Berry College. I further understand that if I refuse to take the test, fail to report for the test, or if the test establishes a violation of the drug testing policy, I will face disciplinary action set forth by the drug testing policy.

By signing and dating this form I consent to take a urinalysis or other drug test as appropriate when requested. The drug testing will be performed by the Director of the Health and Wellness Center with athletes being notified on the day they are to report for urinalysis.

I understand that the results of any drug test will or may be viewed by or disclosed to the Director of Sports Medicine, the Director of Athletics, the Dean of Students, and possibly other members of the Administration or Athletic Department on a need to know basis so as to permit the proper enforcement of this policy, the Viking Code of Conduct, or other applicable Berry policies. I hereby release Berry College, its officers, trustees, employees, students, independent contractors, and other agents or representatives from any and all claims of whatever kind or nature, known or unknown, arising out of the implementation or enforcement of this policy, disclosure of test results, and my consent to the terms of this policy.

Student Athlete’s name (print):______

Student Athlete’s signature:______Date:______

I/We, as Parents and/or Legal Guardians for the Athlete named-above hereby acknowledge that we have read and understand this Agreement and hereby agree to be bound by the same terms and conditions as outlined herein. In the event the Athlete is under the age of 18 at the time of executing this Agreement we hereby indicate our assent and agreement hereto on the Athlete’s behalf.

Parent/guardian’s name(s) (print):______

Parent/guardian’s signature:______Date:______

Parent/guardian’s signature:______Date:______