Random Drug and Alchol Testing consent form.
	MIDDLETOWN TOWNSHIP SCHOOL DISTRICT Random Drug and Alcohol Testing Program Student-Parent/Guardian Consent Form I understand fully that my performance, as a participant, and the reputation of my school are dependent, in part, on my conduct as an individual.  I hereby agree to accept and abide by the standards, rules and regulations set forth by the Middletown Township Board of Education and the sponsors for the activity in which I participate. I authorize the Middletown Township School District to conduct a test on urine, which I provide on-site, to test for alcohol and/or drug use if my identification number (ID) is drawn from the random pool.  Pursuant to the Regulations for the Student Random Drug and Alcohol Testing Policy, I also authorize the release of information concerning the results of such tests to designated District personnel. I understand that I may also be randomly drug and alcohol tested for a period of 365 days from the date this form is received and I have read and understand the Administrative Guidelines on Random Drug and Alcohol Testing. I understand that in the event of a positive result, my club advisor, coach, or administrator will be notified, will maintain confidentiality, and will not share the information with any individual or agency.  The form must be returned within one (1) week of distribution.  A student will not be able to participate until the form is returned. _______________________________                                    __________________ Student name (print)                                                         Student ID # _______________________________                                     __________________ Student signature                                                                   Date  _________________________________                                     _________________ (If the student is under the age of 18)                                                Work phone        Parent/Guardian name (print)                                                                _______________________________                                          __________________             (If the student is under the age of 18)                                                      Date                        Parent/Guardian signature                                                                          _________________________                                                    __________________                       Home Phone                                                                Parent/Guardian cell phone Please check participation in: _____ Athletic Program                      ____    Co-Curricular Activity or School Club _____  On-Campus Parking                ____     I am volunteering to be placed in the        testing pool