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CAIRN UNIVERSITY ATHLETICS Acknowledgement and Consent Form for Drug and Alcohol Testing
I hereby acknowledge that I have read and understand the Cairn University Athletic Department Drug and Alcohol Testing Policy. I understand that Cairn University reserves the right to conduct tests for the presence of alcohol and illegal drugs, and that a positive test result may subject me to disciplinary action. I understand that failure to consent to or comply with the requirements of this policy will result in suspension from participation or termination of eligibility to participate in intercollegiate athletics at Cairn University. I also acknowledge and agree that I am responsible for reading, understanding, and obeying the University policy regarding alcohol and drug use testing. I further authorize the testing laboratory to disclose the results of any such tests to the Director of Athletics and Athletic Training Staff or to such other persons designated by the Director of Athletics to receive confidential information. In the event my drug test result is positive, I understand that I have 72 hours following receipt of notice of the laboratory finding, to contest the finding of the positive results. Upon the student-athlete’s request for additional testing of the sample, the Director of Athletics will formally request B specimen confirmation. The student-athlete may choose to be present at the opening of B specimen at the laboratory Drug Test at his or her expense. I acknowledge that this policy is a term and condition of athletic participation at Cairn University. I agree to comply with the University regulations and policy regarding drug and alcohol use and testing.
_______________________________ Signature of Student-Athlete
_____________________ Date
_______________________________ Print Name of Student-Athlete
_______________________________ Signature of Parent/Guardian (if under the age of 18)
200 Manor Avenue, Langhorne, PA 19047-2990 215.702.4404 • F: 215.702.4401 cairnhighlanders.com
I hereby acknowledge that I have read and understand the Cairn University Athletic Department Drug and Alcohol Testing Policy. I understand that Cairn University reserves the right to conduct tests for the presence of alcohol and illegal drugs, and that a positive test result may subject me to disciplinary action. I understand that failure to consent to or comply with the requirements of this policy will result in suspension from participation or termination of eligibility to participate in intercollegiate athletics at Cairn University. I also acknowledge and agree that I am responsible for reading, understanding, and obeying the University policy regarding alcohol and drug use testing. I further authorize the testing laboratory to disclose the results of any such tests to the Director of Athletics and Athletic Training Staff or to such other persons designated by the Director of Athletics to receive confidential information. In the event my drug test result is positive, I understand that I have 72 hours following receipt of notice of the laboratory finding, to contest the finding of the positive results. Upon the student-athlete’s request for additional testing of the sample, the Director of Athletics will formally request B specimen confirmation. The student-athlete may choose to be present at the opening of B specimen at the laboratory Drug Test at his or her expense. I acknowledge that this policy is a term and condition of athletic participation at Cairn University. I agree to comply with the University regulations and policy regarding drug and alcohol use and testing.
_______________________________ Signature of Student-Athlete
_____________________ Date
_______________________________ Print Name of Student-Athlete
_______________________________ Signature of Parent/Guardian (if under the age of 18)
200 Manor Avenue, Langhorne, PA 19047-2990 215.702.4404 • F: 215.702.4401 cairnhighlanders.com
