ALSD STUDENT CONSENT TO PERFORM URINALYSIS
FOR DRUG / ALCOHOL TESTING

I hereby consent to have my urine collected and tested for the presence of drugs or alcohol in accordance with the Austintown Drug and Alcohol Testing Policy for Student/ Athletes.

I understand that this testing will occur in accordance to the guidelines of the Austintown Drug and Alcohol Testing Policy for Student/ Athletes.

I understand that any urine samples taken for drug/ alcohol testing will be sent only to a certified medical laboratory for actual testing.

I hereby give my consent to the medical laboratory selected by the Austintown Local Board of Education, its doctors, employees, or agents together with any clinic, hospital, or laboratory designated by the selected medical laboratory, to perform urinalysis testing on me, for the detection of drugs/ alcohol.

I further give my permission to the medical laboratory selected by the Austintown Local Board of Education, its doctors, employees, or agents, to release all results of these tests to the designated School District employees or agents, if applicable. I understand that positive, adulterated, inconclusive or suspect results will also be made available to me and to my parent(s)/ guardian(s).

I hereby authorize the release of the results of such testing to my parent(s)/ guardian(s).

This consent shall be valid for one year from date of execution.

I hereby in conjunction with my parent/ guardian consent and knowledge, release, waive, and discharge the Austintown Local Board of Education, its individual members, employees, agents and anyone acting on its behalf, from any and all liability claims, or causes of action arising from or related to the urinalysis drug/ alcohol testing for Athletic participation and/ or release of confidential medical information as authorized in this form and in the Drug and Alcohol Testing Policy for Student/ Athletes.

Student Athlete Signature: ___________________________________Date:  _____________________