FNF(EXHIBIT) - STUDENT RIGHTS AND RESPONSIBILITIES: INVESTIGATIONS AND SEARCHES

RANDOM DRUG- AND ALCOHOL-TESTING PROGRAMCONSENT TO TEST FORM

Student Name: _____________________________________________________________

The student and his or her parent(s) or guardian acknowledge that the Hughes Springs Independent School District ("District") has the right to perform random drug and alcohol testing on students who wish to exercise the privilege of participating in extracurricular activities or who wish to exercise the privilege of driving to and from school.

The student and his or her parent(s) or guardian understand that as a condition of the student being allowed to participate in extracurricular activities in the District and/or as a condition of the student being allowed to drive to and from school, the student may be required to undergo and successfully pass a random screening for alcohol, illegal drugs or other banned substances as set forth in the District's FNF policy. The student and his or her parent(s) or guardian acknowledge that they have read and understand this policy and procedure and that they agree to all terms and conditions contained in the policy and procedure.

The student and his or her parent(s) or guardian hereby consent to participate in the random drug- and alcohol-testing program and to the disclosure of testing results to designated District personnel and parent(s) and guardians. The student and his or her parent(s) or guardian further understand that the student's refusal to submit to a drug screening will be treated in the same manner as if the student had tested positive for banned substances.

No student will be penalized academically for testing positive for banned substances during random drug testing.

The privilege of being allowed to participate in extracurricular activities in the District and/or being allowed to drive to and from school is contingent upon the signing of this consent form.

This consent form will remain in effect for the period from the date of signing until the student has graduated from the District, until revoked in writing by the student and/or the parent(s) or guardian, or until a change in Board policy. Any revocation of this consent form will disqualify the student from participating in extracurricular activities or driving to and from school.

______________________________________________________ _________________Student's Printed Name Current GradePupil ID# (leave blank)

______________________________________________________ _________________Student's SignatureDate

______________________________________________________ _________________Parent's/Guardian's Printed NameWork Phone

______________________________________________________ _________________Parent's/Guardian's SignatureDate

_______________________________________________________________Home Phone Cell Phone

Hughes Springs ISD

FNF(EXHIBIT)-X

LDU 2012.02

DATE ISSUED: 6/14/2012