Manhattan Beach Athletic Foundation
Voluntary (Random) Drug Testing
Testing Choice Form

Please indicate your decision to have your student participate (YES) or not participate (NO) in the Voluntary (Random) Drug Testing Program sponsored by the Manhattan Beach Athletic Foundation.

This form must be completed and signed by both parent/guardian and student and we ask that you return the form regardless of your choice.

Circle your choice

Yes.............No

By circling YES, we hereby authorize Complete Drug Testing to collect a urine specimen from my child for drug testing purposes. By circling NO, the testing choice form will be filed for record keeping purposes only. We understand that the results of the testing will be private and will not be shared with the Manhattan Beach Athletic Foundation, the Manhattan Beach Unified School District, Mira Costa High School or coaches and teachers. We also understand the cost of the program is $40. Checks should be made payable to the Manhattan Beach Athletic Foundation and returned with this form.


________________________________________________________________________
Student Name Student Signature Date

________________________________________________________________________
Parent/Guardian Name Parent/Guardian Signature Date

________________________________________________________________________
Home Street Address/City/Zip


Parent/Guardian Home Phone____________________ Work Phone_________________


Return to:
Manhattan Beach Athletic Foundation
c/o Complete Drug Test Company
PO Box 1585
Manhattan Beach, CA 90267-1585


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