Fill and Sign the General Consent Form

General Consent Form for Drug Testing The undersigned ____________________________________ (name of person being tested) does hereby acknowledge receipt of Drug Testing Policy Statement of _______________________________ _______________________________ (name of organization) and acknowledge further that I have received a copy of this Statement from __________________________________________ _______________________________ (name of organization) . A copy of this Statement is attached to this Consent Form as Exhibit A and initialed by me. I have read the Statement and understand its contents and agree to submit to urine specimen collection(s) for purposes of analysis for drug use. I further agree and consent to the disclosure of the records and test results relating to this analysis to be released to __________________________________________________________ (name of person or title of office – should only be given on a need to know basis) in order that my eligibility to ___________________________________________________________________ _____________________________________________________________________________ _(reason for testing, e.g., participate in a school’s athletic program) may be determined. I accept to the method of obtaining urine samples, testing and analyses of the specimens, and all other aspects of the program, and I agree to cooperate in furnishing urine specimens that may be required from time to time. I give this consent pursuant to all State and Federal Privacy Statutes and I waive all rights to nondisclosure of this test record and results. Witness my signature this the ____ day of __________________, 20_____. ______________________________ (Name of Person Being Tested) _______________________________________ Witness