Drug Test Consent Form

Lakeland School Corporation
Lakeland High School
Drug, Alcohol, and Tobacco Testing Program

Consent Form

I have received and read and understand a copy of the Lakeland High School Corporation

Random Drug Testing Policy and the code of conduct expectations. Access the Random
Drug Testing Policy and code of conduct from the Lakeland High School website
www.lakeland.k12.in.us under the heading of LHS Student Handbook. I, desire to participate in this program, as well as the athletic program, co-curricular program, and/or drive to school. I hereby voluntarily agree to be subject to all of its terms, I accept the method of obtaining urine samples, testing, and analyses of such specimen, and all other aspects of this program. I, the student, agree to cooperate in furnishing urine specimens that may be required from time to time.

I further agree and consent to the disclosure of the sampling, testing and results provided for in this program. This consent is given pursuant to all state and federal privacy statues, and is a waiver of rights to nondisclosure of such test records and results only to the extent of disclosures authorized in the program.

The student and parent/guardian must sign if the student is less than eighteen years of age.
Signature by Custodial Parent or Guardian indicates consent for child or ward to
participate in the Random Drug Testing Program.