2015-2016 Drug Testing Consent Form

Student Name (Please Print) ______

LAST FIRST

Student ID # ______

Please check all extra-curricular activities in which you are involved:

Art Club / MVP (Volleyball) / Band
Blue Crew/Panther Patrol / BPA / C2BK
Cheer / Choir / Diamond Darlings/Dudes
ECO Club / FCCLA / FFA
French Club / German Club / Goal Tenders
HOSA / Link Crew / NHS
Newspaper / Orchestra / PAL’s
Robotics / ROTC / Soccer Sidekicks
Spanish Club / Speech/Debate / Student Council
TAFE / Theatre / UIL Academics
Yearbook / Athletics (please list):

.

Acknowledgement and Consent

I hereby consent and agree to the testing of the student named above as provided in Board Policy FNF(LOCAL) and the Administrative Procedures for the Midway I.S.D. Mandatory Drug Testing Program for Students Participating in Extracurricular Activities.

Parent/Guardian Signature: ______

Student Signature: ______ID #______

Date: ______

Refusal to Participate

The student named above does not have my consent to participate in the drug testing program. I understand that the student will not be allowed to participate in extracurricular activities at Midway I.S.D.

Parent/Guardian Signature: ______

Date: ______

8/10/2015