DAVISSCHOOLDISTRICT
RandomDrugTestingConsentForm
StatementofPurposeandIntent
Participationinschool‐sponsoredextracurricularactivitiesintheDavisSchoolDistrict(District)isaprivilege.
Studentswhoparticipateinstudentgovernment,cheerleading,andcompetitiveathleticactivitiesatthehigh
schoollevelrepresenttheschoolwithinthecommunityandhavearesponsibilitytoconductthemselvesatall
timesinamannerbefittingtheirpositions,whichincludesavoidingtheuseofillegalandperformance‐
enhancingdrugs.
TheBoardofEducationhasimplementedthisrandomdrugtestingprogramforstudentsingradenine(9)
throughtwelve(12)whovoluntarilyparticipateinextracurricularactivitiesatthehighschoollevelasoneway
toprevent,deter,anddetectdruguseamongstudents.
ParticipationinExtracurricularActivities
EXTRACURRICULARACTIVITIESCOVEREDUNDERTHISCONSENTFORMINCLUDE:
BASEBALL;CROSSCOUNTY;FOOTBALL;LACROSSE;GOLF;SOCCER;TENNIS;VOLLEYBALL;SOFTBALL;WRESTLING;BASKETBALL;DRILL
TEAM;SWIMMINGANDDIVING;TRACKANDFIELD;CHEERLEADING;STUDENTOFFICERS.
Inorderforastudenttoparticipateintheschool‐sponsoredextracurricularactivitieslistedabove,the
student’sparent/guardianmustconsenttotheirstudent’sparticipationintherandomdrugtestingprogram.
Astudentparticipator’snamewillremainintherandompoolthroughouthis/herextracurricularcareerwithin
theDistrict.Therefore,astudentparticipatingincompetitiveathleticsmaybeselectedforarandomdrugtest
duringhis/her“offseason.”
Studentsarerandomlyselectedfromamongotherstudentparticipantsatthesameschool.Asaresult,a
particularstudentmightbeselectedmorethanonce,whileanotherstudentmaynotbeselectedatall.
Astudentwhoisrandomlyselectedwillbeprivatelynotifiedtoreporttoadesignatedsiteathis/herschoolto
provideaurinesamplefordrugtesting.Alicensedprofessionalfromastate‐approved,certifieddrugtesting
agencywillconductallurinesamplecollection.Ifastudentrefusestoprovideasampleatthetimeof
collection,orprovidesanadulteratedorfraudulentsampleitwillbecountedasapositivetest.
Parents/guardianswillnotbecontactediftestingresultsarenegative.Ifatestresultispositive,parentswill
becontactedbyaschooladministrator,andgivenanopportunitytodiscussthetestresults.
Ifastudent’stestispositive,he/shewillbesubjecttotheconsequencesoutlinedinDistrictPolicy5S‐204.
ConsentofParent/LegalGuardian:IconfirmthatIhavereadandunderstandtheinformationcontained
herein.
_________________________________________________________________________________
Parent/LegalGuardian’sName(Print)Parent/LegalGuardian’sSignatureDate
Student:Iunderstandandagreetoabidebythispolicy.
_________________________________________________________________________________
Student’sName(Print)Student’sSignatureDate
Aconsentformmustbecompletedatleastannually.
DSDApril29,2021