I hereby consent to the taking of a urine sample to be used fora drug screening test (a “sample”). I specifically authorize collection and screening of my sample(s). I have been informed and understand that I retain the express right to stop the taking of the sample and/or testing of my sample(s) at any time and that I may leave the room at any time.
I hereby authorize and direct the release of my test results to my school, Reitz Memorial High School, or an authorized agent thereof.
I understand that this authorization to release screening test results will remain in effect unless revoked in writing and that I may revoke this authorization at any time (except to the extent that action has been taken in reliance thereon), but that in no event may the release from liability be revoked or nullified in any manner.
By signing this consent and in consideration for the agreement to perform the drug screening test at no cost to the undersigned, I agree to forever release and hold harmless the Catholic Diocese of Evansville and Reitz Memorial High School from any and all liability whatsoever arising from collecting my sample(s) and releasing the results of my drug screening test to the above-named school. I further specifically agree to relinquish any and all rights to privacy I may have with regard to the release of my results of my drug screening test to the Principal or Principal’s designee as per the Reitz Memorial High School Drug, Alcohol, and Tobacco Use and Testing Policy.
Please Note: Throughout the document, the term "minor" refers to ALL Reitz Memorial students. The following form must be signed by BOTH a parent/guardian and each student, regardless of if the child is over 18 years of age.