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I hereby
consent to have my son / daughter undergo urinalysis testing for the presence
of drugs or alcohol in accordance with the Pickerington Drug and Alcohol
Testing Policy for Student Athletes. I understand
that this testing will occur according to the guidelines of the Pickerington
Drug and Alcohol Testing Policy for Student Athletes. I understand
that any urine sample taken for drug / alcohol testing will be sent only to a
certified medical laboratory for actual testing. I hereby give
my consent for the medical laboratory selected by the Pickerington 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 my son / daughter for the detection of drugs /
alcohol. I further
give my permission to the medical laboratory selected by the Pickerington
Board of Education, its doctors, employees, or agents, to release all results
of these tests to designated School District employees or agents. I
understand that these results will also be made available to me. THIS FORM MUST
BE ACCOMPANIED BY A STUDENT CONSENT FORM. I hereby
release, waive, and discharge the Pickerington 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 the athletic participation and / or
the release of related information as authorized in this form and in the Drug
and Alcohol Testing Policy for Student Athletes. __________________________________
______________ __________________________________
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I hereby
consent to have my urine collected and tested for the presence of drugs or
alcohol in accordance with the Pickerington Drug and Alcohol Testing Policy
for Student Athletes. I understand
that this testing will occur according to the guidelines of the Pickerington
Drug and Alcohol Testing Policy for Student Athletes. I understand
that my urine samples taken for drug / alcohol testing will be sent only to a
certified medical laboratory for actual testing. I hereby give
my consent for the medical laboratory selected by the Pickerington 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 Pickerington
Board of Education, its doctors, employees, or agents, to release all results
of these tests to designated School District employees or agents. I
understand that these 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 FORM MUST
BE ACCOMPANIED BY A PARENT / GUARDIAN CONSENT FORM. I hereby
release, waive, and discharge the Pickerington 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 the athletic participation and / or
the release of related information as authorized in this form and in the Drug
and Alcohol Testing Policy for Student Athletes. __________________________________
______________ |