Student-Athlete Drug Testing Consent Form

Name of Student-Athlete: __________________________________________________________

Agreement

I have thoroughly reviewed and agree to comply with the Cumberland University Student‐Athlete Drug Testing Policy, and I understand that my signature signifies that I have received a copy of the policy and that I understand the purpose, process, and consequences that can result from the drug testing program.

Specimen Collection Consent

I give my full consent to be tested for banned substances as specified in the Cumberland University Student‐Athlete Drug Testing Policy by the means discussed in the policy as frequently as is requested of me.

Release of Information

I authorize the release of any information and records related to my drug tests to be given to the Head Coach of my sport, my parent(s) or legal guardian(s), the Cumberland University Sports Medicine Staff, the Cumberland University Director of Athletics, Dean of Students, Faculty Athletic Representative, and any appropriate University official involved in the student disciplinary process, and I understand that my samples will be sent to a laboratory for analysis in agreement with the Cumberland University Student‐ Athlete Drug Testing Policy. I also waive any privilege that I may have to the aforementioned information.

FAILURE TO SIGN THIS AGREEMENT WILL RESULT IN IMMEDIATE DISMISSAL FROM YOUR

TEAM AND LOSS OF SCHOLARSHIP

Signature of Student-Athlete: _________________________________________ Date:_________________

Signed on ATS