1.                 Each of the undersigned acknowledge, agree or represent that:

 

a.       the Jefferson City School District Student Athletic Handbook ("Handbook") and Drug Testing Policy have been read and are understood;

b.      participation in interscholastic athletics is a privilege and not a right;

c.       he/she is aware of the District's requirements for participation in interscholastic athletics and agrees to abide by and follow the requirements and penalties outlined in the Handbook and Drug Testing Policy;

d.      he/she is aware that the head coach or sponsor of an interscholastic athletic program may impose additional requirements and penalties before allowing a student to participate in an interscholastic athletic program;

e.       currently available drug tests are not 100% reliable and that a false positive test result may occur during the drug testing process.

 

2.                  Each of the undersigned consent and agree with regard to the student named below:

 

a.       that the student will participate in the District's Random Drug Testing Program in exchange for the opportunity to participate in any interscholastic athletics;

b.      that a urine sample may be obtained from the student by a laboratory designated by the Principal/Designee before the student may participate in any interscholastic athletics or if the student is randomly selected to participate in a drug test in exchange for the opportunity to participate in any interscholastic athletics.

c.       that the laboratory selected by the Principal/Designee is authorized to perform a drug test on the urine sample to test for Drug Substances.

d.      to conditionally disclose in accordance with the Drug Testing Policy all over-the-counter or prescription medications being taken by the student just prior to the student furnishing a urine sample with said information being revealed only if the student has a positive drug test.

 

 

_____________________________              ____________________________    ___________

Student Signature                                           Student's Name (Printed)                   Date

 

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Parent Signature                                              Parent's Name (Printed)                      Date