Fill and Sign the Drug Testing Consent Draft Form

NCAA Form 08-3f Academic Year 2008-09 Drug-Testing Consent  NCAA Division III Athletics For: Student-athletes. Action: Sign and return to your director of athletics. Due date: Before your institution’s first competition. Required by: NCAA Constitution 3.2.4.6 and NCAA Bylaws 14.1.4 and 30.5. Purpose: To assist in certifying eligibility. TO: STUDENT-ATHLETE Name of your institution: _________________________________________________________ You must sign this form to participate (i.e., practice or compete) in intercollegiate athletics. Per NCAA Bylaw 30.5-(b), the director of athletics or the director of athletics’ designee shall disseminate a list of banned drug classes to all student-athletes and educate them about products that might contain banned drugs. Please note that the list may change during the academic year, that updates may be found on the NCAA Web site (i.e., www.ncaa.org ) and you will be informed of the procedures your athletic department will use to disseminate updates to the list. The requirement that you sign this form is indicated in the following articles of the NCAA Division III Manual:  Constitution 3.2.4.6  Bylaws 14.1.4 and 30.5 If you have any questions, you should discuss them with your director of athletics. Drug-Testing Consent. By signing this form, you affirm that you are aware of the NCAA drug-testing program, which provides: A student-athlete who tests positive for a banned substance as set forth in Bylaw 31.2.3, shall be declared ineligible for further participation in postseason and regular-season competition during the time period ending one calendar year after the student-athlete’s positive drug test. The student-athlete shall be charged with the loss of a minimum of one season in all sports if the season of participation has not yet begun or a minimum of the equivalent of one full season of participation in all sports if the student-athlete tests positive during his or her season of participation (i.e., the remainder of the contests in the current season and contests in the next season up to the period of time in which the student-athlete was declared ineligible during the previous year). The student-athlete shall remain ineligible until the student-athlete tests negative (in accordance with the testing methods authorized by the NCAA Executive Committee), and the student-athlete’s eligibility is restored by the NCAA Division III Committee on Student-Athlete Reinstatement. [Bylaw 31.2.3] Drug-Testing Consent  Division III Form 08-3f Page No. 2 _________ A student-athlete who tests positive (in accordance with the testing methods authorized by the Executive Committee) shall be charged with the loss of a minimum of one season of participation in all sports if the season of participation has not yet begun for that student-athlete or a minimum of the equivalent of one full season of participation in all sports if the student-athlete tests positive during his or her season of participation (i.e., the remainder of the contests in the current season and contests in the next season up to the period of time in which the student-athlete was declared ineligible during the previous year). The student-athlete shall remain ineligible for all regular-season and postseason competition during the time period ending one calendar year (i.e., 365 days) after the student-athlete’s positive drug test and until the student-athlete tests negative (in accordance with the testing methods authorized by the Executive Committee) and the student-athlete’s eligibility is restored by the Committee on Student-Athlete Reinstatement. [Bylaw 18.4.1.5] If the student-athlete who tested positive for any drug other than a “street drug” as defined in Bylaw 31.2.3.4 tests positive a second time for the use of any drug other than a “street drug” as defined in Bylaw 31.2.3.4, he or she shall lose all remaining regular-season and postseason eligibility in all sports. If the student-athlete tests positive for the use of a “street drug” after being restored to eligibility, he or she shall be charged with the loss of a minimum of one additional season of participation in all sports and also shall remain ineligible for regular-season and postseason competition at least through the next calendar year. [Bylaw 18.4.1.5] If a student-athlete transfers to another NCAA institution while ineligible, the institution from which the student-athlete transferred must notify the institution that the student-athlete is ineligible. If the student-athlete immediately transfers to a non-NCAA institution while ineligible and competes in collegiate competition within the 365-day period at the non-NCAA institution, the student-athlete will be ineligible for all NCAA regular-season and postseason competition until the student-athlete does not compete in collegiate competition for a 365-day period. Furthermore, the student-athlete must retest negative (in accordance with the testing methods authorized by the Executive Committee), and the student-athlete’s eligibility must be restored by the Committee on Student-Athlete Reinstatement. [Bylaw 18.4.1.5] The Executive Committee shall adopt a list of banned drugs and shall authorize methods for drug testing of student-athletes on a year-round basis. This list of banned drugs and the procedure for informing member institutions about authorized methods for drug testing are set forth in Bylaw 31.2.3.4. The list is subject to change and the institution and student-athlete shall be held accountable for all banned drug classes on the current list. The list is located on the NCAA Web site ( www.ncaa.org ) or may be obtained from the NCAA health and safety staff in Education Outreach. [Bylaw 18.4.1.5] You agree to allow the NCAA to test you in conjunction with any NCAA championship or in any postseason football game certified by the NCAA for the banned drugs listed in Bylaw 31.2.3. Drug-Testing Consent  Division III Form 08-3f Page No. 3 _________ You agree to allow your drug-test sample to be used by the NCAA drug-testing laboratories for research purposes to improve drug-testing detection. Individual samples will not be personally identified. You were provided an opportunity to review the procedures for NCAA drug testing that are described in the NCAA Drug-Testing Program brochure. You understand that this consent and the results of your drug tests, if any, only will be disclosed in accordance with the provisions of the Buckley Amendment Consent. You agree to disclose your drug-testing results only for purposes related to your eligibility for participation in regular-season and postseason competition. You agree that you have received a copy of the NCAA list of banned substances. You affirm that you understand that if you sign this statement falsely or erroneously, you violate NCAA legislation regarding ethical conduct, and you will further jeopardize your eligibility. By signing below, you consent to be tested by the NCAA in accordance with the rules and regulations of NCAA drug-testing policy. _______________________ _________________________________________________ Date Signature of Student-athlete _______________________ _________________________________________________ Date Signature of Parent (if student-athlete is a minor) _________________________________________ ________________________ _____ Name (Please Print) Date of Birth Age _____________________________________________________________________________ Home Address ______________________________________________________________________________ Sport(s) What to do with this form: Sign and return it to your director of athletics before you first compete each year. This form is to be kept in the director of athletics office for six years . The National Collegiate Athletic Association June 24, 2008 JB:kh Attachment Form 08-3f NCAA Banned-Drug Classes 2008-09 The NCAA list of banned-drug classes is subject to change by the NCAA Executive Committee. Contact NCAA education services or www.ncaa.org/health-safety for the current list. The term “related compounds” comprises substances that are included in the class by their pharmacological action and/or chemical structure. No substance belonging to the prohibited class may be used, regardless of whether it is specifically listed as an example. Many nutritional/dietary supplements contain NCAA banned substances. In addition, the U.S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore purity and safety of nutritional dietary supplements cannot be guaranteed. Impure supplements may lead to a positive NCAA drug test. The use of supplements is at the student-athlete’s own risk. Student-athletes should contact their institution’s team physician or athletic trainer for further information. Bylaw 31.2.3. Banned Drugs The following is a list of banned-drug classes , with some examples of substances under each class. No substance belonging to the banned drug class may be used, regardless of whether it is specifically listed as an example. (a) Stimulants: amiphenazole methylenedioxymethamphetamine amphetamine (MDMA, ecstasy) bemigride methylphenidate benzphetamine nikethamide bromantan pemoline caffeine1 (guarana) pentetrazol chlorphentermine phendimetrazine cocaine phenmetrazine cropropamide phentermine crothetamide diethylpropion phenylpropanolamine (ppa) dimethylamphetamine picrotoxine doxapram pipradol ephedrine prolintane (ephedra, ma huang) strychnine ethamivan synephrine ethylamphetamine (citrus aurantium, zhi shi, bitter fencamfamine orange) meclofenoxate and related compounds methamphetamine The following stimulants are not banned: phenylephrine pseudoephedrine (b) Anabolic Agents: anabolic steroids androstenediol gestrinone androstenedione mesterolone boldenone methandienone Attachment Form 08-3f Page 2 clostebol methyltestosterone dehydrochlormethyl- nandrolone testosterone norandrostenediol dehydroepiandro- norandrostenedione sterone (DHEA) norethandrolone dihydrotestosterone oxandrolone (DHT) oxymesterone dromostanolone oxymetholone epitrenbolone stanozolol fluoxymesterone testosterone2 tretrahydrogestrinone (THG) trenbolone and related compounds Other anabolic agents clenbuterol (c) Substances Banned for Specific Sports: Rifle: alcohol pindolol atenolol propranolol metoprolol timolol nadolol and related compounds (d) Diuretics and other urine manipulators: acetazolamide hydrochlorothiazide bendroflumethiazide hydroflumethiazide benzhiazide methyclothiazide bumetanide metolazone chlorothiazide polythiazide chlorthalidone quinethazone ethacrynic acid spironolactone flumethiazide triamterene furosemide trichlormethiazide and related compounds (e) Street Drugs: heroin tetrahydrocannabinol marijuana3 (THC)3 (f) Peptide Hormones and Analogues: corticotrophin (ACTH) growth hormone (hGH, somatotrophin) human chorionic gonadotrophin (hCG) insulin like growth factor (IGF-1) leutenizing hormone (LH) (all the respective releasing factors of the above- mentioned substances also are banned.) erythropoietin (EPO) sermorelin darbypoetin Attachment Form 08-3f Page 3 (g) Anti-Estrogens anastrozole clomiphene tamoxifen and related compounds (h) Definitions of positive depends on the following: 1for caffeine—if the concentration in urine exceeds 15 micrograms/ml. 2for testosterone—if the administration of testosterone or use of any other manipulation has the result of increasing the ratio of the total concentration of testosterone to that of epitestosterone in the urine to greater than 6:1, unless there is evidence that this ratio is due to a physiological or pathological condition. 3 for marijuana and THC—if the concentration in the urine of THC metabolite exceeds 15 nanograms/ml. 31.2.3.4.1 Drugs and Procedures Subject to Restrictions. The use of the following drugs and/or procedures is subject to certain restrictions and may or may not be permissible, depending on limitations expressed in these guidelines and/or quantities of these substances used: (Revised: 8/15/89) ( a) Blood Doping . The practice of blood doping (the intravenous injection of whole blood, packed red blood cells or blood substitutes) is prohibited, and any evidence confirming use will be cause for action consistent with that taken for a positive drug test. (Revised: 8/15/89, 5/4/92) ( b) Local Anesthetics . The Executive Committee will permit the limited use of local anesthetics under the following conditions: (1) That procaine, xylocaine, carbocaine or any other local anesthetic may be used, but not cocaine; (Revised: 12/9/91, 5/6/93) (2) That only local or topical injections can be used (i.e., intravenous injections are not permitted); and (3) That use is medically justified only when permitting the athlete to continue the competition without potential risk to his or her health. (c) Manipulation of Urine Samples . The Executive Committee bans the use of substances and methods that alter theintegrity and/or validity of urine samples provided during NCAA drug testing. Examples of banned methods are catheterization, urine substitution and/or tampering or modification of renal excretion by the use of diuretics, probenecid, bromantan or related compounds,and epitestosterone administration. (Revised: 8/15/89, 6/17/92, 7/22/97) (d) Beta 2 Agonists . The use of beta 2 agonists is permitted by inhalation only. (Adopted: 8/13/93) (e) Additional Analysis . Drug screening for select nonbanned substances may be conducted for nonpunitive purposes. (Revised: 8/15/89)