Activities Policies and Forms

The information below is provided to and signed by parents and student-athletes each year.

 

A sports related concussion is a traumatic brain injury, caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise related activity. Symptoms and signs may present immediately or evolve over minutes to days. Sports related concussions commonly resolve within days but may be prolonged. All concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. If a student reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.

 

Symptoms may include one or more of the following:

• Headaches/“Pressure in head”
• Nausea or vomiting
• Neck pain
• Balance problems or dizziness
• Blurred, double, or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish or slowed down
• Feeling foggy or groggy
• Drowsiness
• Change in sleep patterns
• “Don’t feel right”
• Unexplained nervousness, anxiety, irritability, sadness
• Confusion
• Concentration or memory problems (forgetting sport assignments)
• Repeating the same question/comment

This form is digitally signed during online enrollment. The content is provided here for reference. 

 

 

We/I understand that our/my student may be injured while participating in activities, interscholastic athletic practices or contests and/or field trips as a McPherson High School or McPherson Middle School Student. Injuries in interscholastic athletics have been known to range from a slight bruise or scratch to broken bones, injuries to teeth and jaws, strains, sprains, cuts requiring stitches, torn ligaments, head injuries that could cause brain damage or paralysis, injuries to the vertebral column that may cause quadriplegia and/or injuries that may even cause death.

 

We know that participation in sports activities requires an acceptance of the risk of possible injury and that the player can make the contest safer for all by not intentionally using techniques which are illegal and which can cause serious injury to themselves or others. We further acknowledge that we, the parent/student, are responsible for any medical bills that might be incurred. The school district does not have insurance to cover initial medical expenses of students injured in accidents while participating in school activities. The district does purchase through KSHSAA a catastrophic medical insurance policy for students participating in interscholastic activity programs to cover excess medical costs. This policy has a $25,000 deductible and pays a limited amount of costs not covered by a primary insurance policy. For further information, contact KSHSAA (1-785-273-5329) or McPherson High School.

 

With the knowledge of the above information we/I do allow our student to participate in McPherson High School or McPherson Middle School activities, athletic programs, and/or field trips for the current school year.

 

Certain standards of social behavior are expected of all students. However, since students in athletics, activities, and on field trips are more visible representative of their school and community they will be expected to meet higher standards of conduct and discipline. The following rules apply to all students participating in athletics, activities, or field trips at McPherson High School or McPherson Middle School.

1. There will be no possession and/or use of unauthorized drugs, steroids, alcoholic beverages, or any form of tobacco. Any student who is suspended from school attendance, or who is convicted by the civil authorities for the possession and/or use of these substances, or who is observed by any coach, sponsor, teacher, or administrator in the possession and/or use of these substances, or if the student admits to the possession and/or use of any of these substances, the student will be suspended from the respective team or club until a hearing is held.
2. Any action by the student that is perceived by the coach, instructor, sponsor and/or administration to bring discredit upon the school, or community may result in the student being suspended from the team or club until a hearing is held. A hearing for suspected violation of (1.)3. 4. and/or (2.) above will be held and due process will be followed. The coach/instructor/sponsor, parent, student, and accuser (if applicable) will be notified as to the time and location. The principal, or assistant principal, will serve as hearing officer. The penalty will be determined at the hearing and may result in suspension or expulsion from the club, activity, or athletic team.
3. The student may not practice or participate in a contest, activity, or field trip on a day they miss any part of the school day unless they are given prior approval by the assistant principal/activities director. When calling the school to make arrangements, the parent should be sure to call the office of the assistant principal/activities director at 241-9510. If for any reason the student’s absence is not detected and the student takes part in the day’s activities, they will be held out of the next corresponding activity, athletic contest or practice held immediately after the absence is detected.
4. A student becomes a member of a school-sponsored team or club at the time he/she begins practice with that team or enrolls. At that time, the student is considered to have made a commitment to complete that season of sport, club or activity.

Participation in the required number of practices must be completed prior to travel and/or interscholastic competition with the new team. An appeal process is available if a student is not satisfied with the original decision of the two coaches and activities director. Each individual coach, sponsor, or instructor may implement additional rules. These rules, approved by the high school activities director, may cover such areas as follows:

1. Missing practice
2. Being late for practice
3. Care of equipment
4. Swearing/vulgar language
5. Disrespect to staff and/or team
6. Sportsmanship

READ INFORMED CONSENT AGREEMENT BELOW. IN ORDER TO PARTICIPATE IN KSHSAA ACTIVITIES, STUDENTS/PARENTS MUST SIGN PRIOR TO PARTICIPATION, OR BY OCTOBER 1ST, WHICHEVER COMES FIRST.

 

We hereby consent to allow the student named on the top of this form to undergo urinalysis testing for the presence of illicit drugs or banned substances in accordance with the Policy for Random Urine Drug Testing of USD 418 Students Involved in KSHSAA Activities Grades 7-12 (policy can be read below as approved by the McPherson Unified School District Board of Education). We understand that a qualified vendor will oversee the collection process. We understand that any urine samples will be sent only to a certified medical laboratory for actual testing, and that the samples will be coded to provide confidentiality.

 

We hereby give our consent to the medical vendor selected by the McPherson USD 418 Board of Education, their laboratory, doctors, employees, or agents, together with any clinic, hospital, or laboratory designated by the selected medical vendor to perform urinalysis testing for the detection of illicit drugs or banned substances.

 

We further give permission to the medical vendor selected by the McPherson USD 418 Board of Education, its doctors, employees, or agents, to release all results of these tests to the Medical Review Officer (MRO) working for the medical vendor. We understand these results will be forwarded to the Building Principal and will also be made available to us. We understand that consent pursuant to this Informed Consent Agreement will be effective for all activities as defined by board policy in which this student might participate during the current school year.

 

AS A STUDENT:

• I understand and agree that participation in KSHSAA-sponsored school activities is a privilege that may be withdrawn for violations of the Policy for Random Urine Drug Testing of USD 418 Students Involved in KSHSAA Activities Grades 7-12.
• I have read the Policy for Random Urine Drug Testing of USD 418 Students Involved in KSHSAA Activities Grades 7-12 and understand the consequences that I will face if I am selected for a random drug test and have a positive test result.
• I understand and realize that there is risk of injury in participating in athletic activities.
• I understand that when I participate in any KSHSAA sponsored extracurricular activity as defined in Board Policy, I may be subjected to initial drug testing and will be subject to random urine drug testing, and if I refuse, I will not be allowed to practice, or participate in any KSHSAA-sponsored extracurricular activity. I have read the consent on the top of this form and agree to its terms.
• I understand this is binding while a student in USD 418.

[Placeholder for Student Signature and Date]

 

AS A PARENT/GUARDIAN/CUSTODIAN:

• I have read the Policy for Random Urine Drug Testing of USD 418 Students Involved in KSHSAA Activities Grades 7-12 and understand the responsibilities of my son/daughter/ward as a participant in KSHSAA sponsored extracurricular activities in USD 418.
• I understand and realize that there is an assumed risk of injury involved for my son/daughter/ward as a participant in athletic activities.
• I understand that my son/daughter/ward, when participating in KSHSAA sponsored extracurricular activities as defined in Board Policy, may be subjected to initial and random urine drug testing, and if they refuse, will not be allowed to practice or participate in any extracurricular activities. I have read the consent on the top of this form and agree to its terms.
• I understand this is binding while my son/daughter/ward is a student in USD 418.

 

[Placeholder for Parent/Guardian Signature, Phone Number and Date]

 

 

RELEASE OF INFORMATION FORM FOR MEDICAL REVIEW OFFICER

(TOP PORTION MUST BE FILLED OUT PRIOR TO PARTICIPATION OR BY OCT. 1ST, WHICH EVER COMES FIRST.

[Placeholder for Student Name and Student Number]

 

I understand I am submitting to a urine drug screen for USD 418 school system. If needed, I give permission for the Medical Review Officer to contact my parent/guardian/custodian regarding results and verify any prescription medicine I may be taking at the time of the drug screen collection. Contact information listed below.

Name of Parent/Guardian/Custodian:
Relationship (Mother/Father/Guardian Etc):

Identification (last 4 of parents SSN - will be used by MRO for verification process):

Daytime phone:

Evening phone:

 

Student Consent (To be filled out at the time of drug screening):

[Date - Signature - Witness]

 

 

MHS/MMS KSHSAA SPONSORED EXTRACURRICULAR ACTIVITIES

Athletic: 

• Boys/Girls Cross Country 
• Football 
• Boys/Girls Soccer 
• Boys/Girls Tennis 
• Boys/Girls Basketball 
• Boys/Girls Golf 
• Wrestling 
• Baseball 
• Volleyball 
• Softball 
• Track & Field
• Boys/Girls SwimmingBoys/Girls Bowling
• Cheerleading
• Hi-Stepper Dance Squad

Activities:

• Debate
• Forensics
• Band
• Orchestra
• Vocal Music
• National Honor Society
• Student Council
• KAY
• Scholar’s Bowl
• Other BOE-approved activities or athletics

Policy for Urine Drug Testing of McPherson USD 418 Students Involved in KSHSAA Sponsored Activities Grades 7-12

 

OVERVIEW

The USD 418 Board of Education, in an effort to protect the health and safety of its students involved in KSHSAA sponsored extracurricular activities from illegal drug and alcohol use and abuse or injuries resulting from the use of illegal drugs and or alcohol adopts this policy for drug testing of students participating in KSHSAA sponsored extracurricular activities. The procedure for random and possible initial drug testing of middle school and high school students participating in KSHSAA sponsored extracurricular activities as defined in this policy is accomplished in conjunction with an independent drug-testing Vendor selected by the USD 418 Board of Education. To facilitate random testing, the Designated Official will provide the Vendor with a list of eligible students and in turn the Vendor will randomly select up to ten percent (10%) of the eligible high school and up to five prevent (5%) of the eligible middle school students for random drug testing at each testing period. The number of students selected for each test will be determined by the Designated Official. In the event the USD 418 Board of Education requires initial drug testing, each student electing to participate in any extracurricular activity will be required to submit to a urine drug test at the beginning of each school year or if a student is new to the district, within 30 days of enrollment in USD 418. The Vendor will send qualified collectors to the school to oversee the collection of all specimens as outlined in this policy and procedure. The Vendor will provide Medical Review Officer (MRO) services for interpretation and verification of results. Results are reported to the Building Principal or Designated Official by the MRO.

 

Specimens are collected as split specimens.

 

Recognizing that observed and suspected use of tobacco, alcohol and illicit drugs by USD 418 students (Grades 7 through 12) is a serious concern; a program of deterrence will be instituted as a pro-active approach to promote a drug free school. Likewise, students using illegal drugs pose a threat to their own safety, as well as to the safety of other students. According to a recent survey of 51 students at MHS involved in activities, over 50% believe drug use is a problem, and in the Pride National survey in 2008-09, over 1/3 of HS seniors admitted to having used drugs.

 

The purpose of this program is fourfold:

1. to provide for the safety of all Students;
2. to undermine the effects of peer pressure by providing a legitimate reason for students to refuse to use illegal drugs;
3. to encourage Students who use drugs to participate in drug treatment programs; and
4. to promote achievement of Students full academic potential by preventing the impact drug and alcohol use has on the learning centers of the brain.

The random drug testing program is academically non-punitive. This policy is designed to create a safe, drug free, environment for students and assist them in getting help when needed. However, to the extent a violation of this policy would also constitute a violation of the District’s policy for Illegal and Controlled Substances (JCDAB), the sanctions of Policy JCDAB will also apply, as will the policies concerning substance abuse in the McPherson Middle and High School handbooks.

 

Participation in KSHSAA sponsored school extracurricular activities is a privilege. Accordingly, students in extracurricular activities carry a responsibility to themselves, their fellow students, their parents, and their school to set the highest possible examples of conduct, which includes avoiding the use or possession of illegal drugs and alcohol.

 

Random urine drug testing in a public school is legal as determined by the United States Supreme Court in the case of Vernonia School District 47J (Oregon) v. Wayne and Judy Acton and Pottawatomie v. Earls.

 

3. DEFINITIONS

Vendor – The medical office or company selected by the Board of Education to carry out the policy and procedure.

Designated Official – The individual hired by the school or district to oversee the drug testing program of the school or district.

KSHSAA – Kansas State High School Activities Association

KSHSAA Sponsored Extracurricular Activities – School-sponsored activities, including:

a. Grades 7-12 competitive athletic teams, including, but not limited to: boys/girls cross country, football, boys/girls soccer, boys/girls tennis, boys/girls basketball, boys/girls golf, wrestling, baseball, volleyball, softball, boys/girls track & field, boys/girls swimming, boys/girls bowling, and other athletics as specified by the Board of Education.

b. Grades 7-12 noncompetitive extracurricular activities including, but not limited to, cheerleading, Hi-Steppers/dance squads, debate, forensics, band, orchestra, vocal music, National Honor Society, Student Council, KAY, scholar’s bowl, and other activities as specified by the Board of Education.

An information list of KSHSAA sponsored extracurricular activities will be prepared by the building principal and may be modified as determined by the building principal.

Medical Review Officer (MRO) – A licensed physician trained and certified in the process and interpretation of drug testing results.

Illicit Substance – A drug classified by the Drug Enforcement Administration (DEA) as being available only by prescription from a physician or classified as being controlled and having no therapeutic use.

Banned Substance – A substance defined by School policy as being banned from use by students.

Student Participant – A USD 418 student participating on a KSHSAA sanctioned athletic team, or any other KSHSAA sponsored extracurricular activity as defined by this policy.

SAMSHA – The Substance Abuse and Mental Health Services Administration is a governmental agency that certifies toxicology laboratories that perform drug testing following strict guidelines and constant quality assurance programs.

GC/MS – Gas Chromatography/Mass Spectroscopy; a scientific process to identify specific chemical compounds. A molecular fingerprint is obtained that identifies a chemical compound with 100% accuracy.

Quantitative Levels – The measurement levels of specific chemicals in the urine reported usually in nanograms per milliliter (ng/ml).

Chain-of-Custody Form – A preprinted form provided by the testing laboratory that records all contact with the provided specimen. The form is initiated by the collector and donor then follows with the specimen until the results are certified by the testing scientist and forwarded to the MRO for final certification.

Adulterant/Adulteration – Any attempt to alter the outcome of a urine drug test by adding a substance to the sample, attempting to switch the sample, or otherwise interfere with the detection of illicit or banned substances in the urine, or purposefully overhydrating oneself in an attempt to dilute the urine to decrease possible detection of illicit or banned substances.

 

4. PROCEDURES FOR STUDENTS

a. Informed Consent for Testing

At the beginning of each school year, students and parent/guardian/custodian will complete and sign the Informed Consent Agreement (Exhibit A) and Release of Information Form for Medical Review Officer (Exhibit C). No student may participate in any extracurricular activity, as defined by this policy, until this form is properly executed and on file with the school. If a student wished to participate at any point during the school year, these forms must be filed prior to beginning the KSHSAA sponsored activity, or by October 1st. Transfer students wanting to participate must complete forms upon arrival if wanting to participate in

KSHSAA activities that school year.

 

b. Urine Drug Testing Frequency

All students wishing to participate in KSHSAA sponsored extracurricular activities as defined by this policy may be subject to urine testing for illegal or banned substances as specified in Paragraph 9 below. Up to ten percent (10%) of eligible students in grades 9-12, and up to five percent (5%) of eligible student in grades 7-8 will be randomly tested on up to a biweekly basis anytime during the school year. Any student who refuses to submit to urine drug testing will not be allowed to participate in extracurricular activities as defined by this policy. The refusal to submit to a urine drug test will be considered the same as a positive drug test result.

 

c. Sample Collection

Samples will be collected as outlined under Vendor Requirements, Paragraph 6 below.

 

Any eligible student randomly selected for urine drug testing who is not in school on the day of testing will be tested at the next available testing time. Students not able to provide an adequate urine specimen at the testing time will be unable to participate in KSHSAA sponsored extracurricular activities and the failure will be considered the same as a positive drug test result. Arrangements may be made for special collections at a Vendor Collection site with prior approval of the Building Principal or Designated Official.

 

d. Tests for Alcohol

Students attending extracurricular activities as may be randomly required to submit to an alcohol breath analyzer test to determine the presence of alcohol.

 

5. CONFIDENTIALITY RESULTS

All drug test results are considered confidential information and will be handled accordingly.

6. VENDOR REQUIREMENTS

At a minimum, the Vendor must be able to provide the following services:

a. Random Selection of Eligible Students

Once provided a list of eligible students, the Vendor must select the required number of students in a random and confidential manner. Up to biweekly, the Vendor will arrange with the Designated Official a day and time to do the collection of specimens. The schedule will not follow any recognizable pattern. The selected student names will be given to the Designated Official, who will arrange for these students to report to the collection area.

 

b. Collection of Urine Specimens

The Vendor will oversee the collection of urine specimens as outlined in the Procedure for Random Urine Drug Testing of McPherson USD 418 Students Involved in KSHSAA Sponsored Activities Grades 7-12. Chain of Custody forms will be provided by the Vendor that meets the criteria of this policy and that of the testing laboratory. Students will be given as much privacy as possible in the obtaining of the specimen.

 

c. Testing of Urine Specimens

The Vendor will have all specimens tested for the specified illicit or banned substances by a qualified laboratory certified by the Substance Abuse and Mental Health Services Administration (SAMSHA) following the guidelines of the Department of Health and Human Services (HHS). The testing laboratory should have greater than 10 years experience in toxicology testing and chain-of-custody procedures. All specimens must be initially tested using a highly accurate immuno-assay technique, with all presumptive positive results then confirmed by a Gas Chromatography/Mass Spectroscopy (GC/MS) confirmatory test (understanding that no current GC/MS test is available for LSD).

 

The testing laboratory must be able to test for the following drug classes, substances or their metabolites in collected urine specimens. The building principal may specify specific classes or substances to be tested and advise the Vendor prior to random testing.

• Alcohol
• Amphetamines/Methamphetamine
• Anabolic Steroids
• Barbiturates
• Benzodiazepines
• Cocaine Metabolites
• LSD
• Marijuana (THC) Metabolites
• Methadone
• MDMA (Ecstasy)
• Nicotine (Cotinine)
• Opiates
• Phencyclidine (PCP)
• Propoxyphene

d. Medical Review Officer (MRO) Services

The Vendor will provide MRO services by a licensed physician who is certified by the Medical Review Officer Certification Council (MROCC) or the American Association of Medical Review Officers as having proven by examination to have had the appropriate medical training to interpret and evaluate drug test results and thus qualified for certification as a Medical Review Officer. Additionally, the MRO must demonstrate a willingness to abide by the Procedure for Random Urine Drug Testing of McPherson USD 418 Students Involved in KSHSAA Sponsored Activities Grades 7-12 as to the evaluation of positive drug

tests and reporting findings in a timely and confidential manner.

 

e. Reporting of Random Urine Test Results by Vendor

The MRO will certify all urine drug screens as negative or positive and report positive findings in a confidential manner to the parent and then the building principal by a secure e-mail system.

 

f. Statistical Reporting and Confidentiality of Urine Drug Test Results

The Vendor, testing laboratory, or MRO may not release any statistics on the rate of positive drug tests to any person, organization, news publication or media without expressed written consent of the McPherson USD 418 Superintendent of Schools. However, the Vendor will provide the building principal with an annual report showing the number of tests performed, rate of positive and negative tests, and what substances were found in the positive urine specimens.

 

7. PROCEDURES IN THE EVENT OF A POSITIVE RESULT

a. Whenever a student’s test result indicates the presence of illegal drugs or banned substances or adulteration, the following will occur after the MRO notifies the parent:

(1) The building principal, within 24 hours, will notify the parent/

guardian/custodian first, then the student and Designated Official of any positive results. A written notification from the building principal, by form letter, will be sent to the parent/guardian/custodian by certified mail. The building principal may keep all test results for a period up to two years or 30 days after the student graduates, whichever is shorter.

(2) The student will be notified and be required to submit to five periodical urine tests throughout the next 12-month period at their own expense to retain activity participation eligibility.

(3) If the parent/guardian/custodian or student wishes to contest the results, the Vendor will arrange for the split portion of the specimen to be submitted to another laboratory approved by the Board of Education for testing. This is done at parent/guardian/custodian or student expense. Such a request

must be made to the building principal in writing within five working days from first notification of positive test results.

(4) The MRO may use quantitative results to determine if positive results on repeat testing indicate recent use of illicit or banned substances or the natural decline of levels of the illicit or banned substance from the body. If the MRO feels the quantitative levels determined to be above the established cutoffs do not reflect current use but natural decay, then a negative result may be reported.

b. First Positive Result

A positive result from the MRO or an altered sample will constitute a first positive. The student participant will be ineligible for next 20% of scheduled competitions/performances, or remainder of season (whichever is shorter), in each KSHSAA activity they are currently involved in, or in the next activity in which they plan to participate. The specific coach or sponsors individual team/group policy may supersede the requirements of this policy based on prior behavior, but cannot be less than the provisions of this paragraph. Additionally, student participants who have a first positive result will be required to submit to five follow-up drug tests during the next twelve (12) month period and will be required to participate in a chemical assessment program to determine the extent of their drug/alcohol use. The student will be required to follow the recommendations of the chemical assessment. The cost of the follow up drug tests, chemical assessment and follow-up plan will be the responsibility of the student or student’s parents or guardian if under age 18.

 

c. Second Positive Result

A second positive result by MRO ruling or adulteration will result in the student participant being declared ineligible from all KSHSAA sponsored extracurricular activities as defined in this policy in which he/she is currently participating and denied participation in future KSHSAA sponsored extracurricular activities for a period of 18 weeks, when school is in session (weeks during summer would not apply, so these 18 weeks can carry over into the next school year). In addition, the student must complete a comprehensive substance abuse program recommended by a certified substance abuse professional. The student will continue or repeat the five necessary follow-up drug screens. The cost of the substance abuse program and follow up drug tests will be the responsibility of the student or student’s parent or guardian if under age 18.

 

d. Third Positive Result

A third positive result will result in the student participant being barred from participation in any KSHSAA sponsored extracurricular activities as defined in this policy for a minimum of one calendar year. In addition, the student must participate in a chemical assessment program and successfully complete a substance abuse program recommended by a certified substance abuse professional at the expense of he student or student’s parents or guardian. (The substance abuse program can not be the same program

for the Second Positive Result). At the end of the one calendar year and successful completion of the substance abuse program, the student must complete another drug screen at the student’s expense, with negative results. Upon return to participation in KSHSAA sponsored extracurricular activities, the student will continue or repeat the five necessary follow-up drug screens at their own expense. The period of exclusion from extracurricular activities may continue into the following school year.

 

e. Additional Positive Result After 3rd Positive

If a student participant would have additional positive results by MRO ruling or adulteration, that student would be barred from participation in KSHSSA sponsored extracurricular activities for an additional one calendar year for each positive result.

 

8. NON-PUNITIVE NATURE OF POLICY

No student will be penalized academically for testing positive for illegal drugs or banned substances. The results of drug tests pursuant to this policy will not be documented in any student’s academic records. Information regarding the results of drug tests will not be disclosed to criminal or juvenile authorities, including the school SRO, unless required to do so by a court order, by a valid and binding subpoena or other legal process. In the event of service of any such court order, subpoena or legal process, the student and the student’s custodial parent, legal guardian, or custodian will be notified at least 72 hours before response is made by the McPherson USD 418 Board of Education, if such notice is allowed by law. However, to the extent a violation of this policy would also constitute a violation of the District’s policy for Illegal and Controlled Substances (JCDAB), the sanctions of Policy JCDAB will also apply.

 

9. ILLICIT OR BANNED SUBSTANCES

For the purpose of this policy, the following drug classes, substances or their metabolites that can be tested for are considered illicit or banned for McPherson Unified School District 418 Students:

• Alcohol
• Amphetamines/Methamphetamine
• Anabolic Steroids
• Barbiturates
• Benzodiazepines
• Cocaine Metabolites
• LSD
• Marijuana (THC) Metabolites
• Methadone
• MDMA (Ecstasy)
• Nicotine (Cotinine)
• Opiates
• Phencyclidine (PCP)
• Propoxyphene

10. REMOVAL OF TEST RECORDS

a. The school district shall remove all records of urine testing and the results thereof from its records within 30 days after the graduation of any student from the USD 418 high school.

b. The school district shall remove from its records all records of any testing and results thereof within 36 months after the withdrawal of any student from the USD 418 school system.

 

1. LIST OF ELIGIBLE STUDENTS

The Designated Official will prepare a list of eligible students. This list will be forwarded to the Vendor for the random selection of students who will submit urine specimens for testing. The Designated Official is responsible for seeing that all students and their parent/guardian/custodian properly sign the Informed

Consent Agreement (Policy Exhibit A) and the Release of Information Form for Medical Review Officer (Exhibit C) prior to testing.

 

2. RANDOM SELECTION OF STUDENTS FOR TESTING

The Vendor will use a system to assure that students are selected in a random fashion. This system will utilize a computer system designed specifically for the purpose of randomly selecting individuals for drug testing.

 

3. SCHEDULING OF URINE DRUG TESTING

Urine drug testing is unannounced. The day and time are selected by the Designated Official and confirmed with the Vendor. Random testing may be done up to bi-weekly, but not during holidays and spring break.

 

4. INITIAL TESTING

At the beginning of the year, all eligible students may be subject to urine drug testing as determined by the Board of Education. This testing will be accomplished on a date and time coordinated with the testing Vendor. Any student moving into the District may be tested prior to participation in any extracurricular activities. A student is only required to take one initial test per year to participate in extracurricular activities.

 

5. TESTING YEAR

The testing year begins the date the first activity for the upcoming school year commences and continues for 365 days thereafter. Those students wanting to participate in a KSHSAA activity anytime during a testing year must have proper forms completed prior to starting the activity or no later than October 1st.

 

6. FORM COMPLETION

The Vendor is responsible for seeing that proper drug testing custody and control forms are used that satisfy the needs of the Policy for Random Urine Drug Testing of McPherson USD 418 Students Involved in KSHSAA Sponsored Activities Grades 7-12 and the testing laboratory. A student number will be used for

identification with the student’s name only appearing on the copies that go to the donor, MRO, and School Official.

 

7. COLLECTION PROCESS

Selected students are escorted from class to the collection site. A specimen of urine is collected following this process:

1. No purses, bags or containers may be taken into the collection area with the student. All extra coats, vests, jackets, sweaters, etc., are to be removed before entering the collection area.
2. The collector adds a bluing agent (food coloring) to the water in the urinal or toilet.
3. The Student is asked to rinse their hands and dry them. If no water is easily accessible, a non-alcoholic wipe may be used instead.
4. The drug testing custody and control form is completed by the Student and collector.
5. The student is told to urinate directly into the provided container and should provide a sufficient amount or urine (at least 30ml) in one attempt. The student is also told they are to hand the container of urine to the collector. If a student is unable to provide a urine sample, the student may drink up to 40 oz. of water and wait 1.5 hours from the initial attempt. The student is not to leave the test area. If unable to provide a urine sample after 1.5 hours, the failure is treated as a refusal to test.
6. The student enters a closed stall to collect the specimen, and then hands the container to the collector.
7. The collector checks the volume, reads and records the temperature within four minutes of collection, and looks for evidence of tampering. If tampering is suspected, a second specimen will be requested. A second suspected tampered specimen will be considered refusal to test and the Designated Official notified.
8. With the student watching, the collector will pour the specimen into the two bottles and recap the specimen bottles tightly.
9. The collector takes the properly signed and initialed bottle seals and places them over the caps and sides of the bottles.
10. The sealed bottles are placed inside the transport bag.
11. The top lab copies of the drug testing custody and control form are folded with the top portion visible to the outside and placed in the Requisition Pouch. The transport bag and pouch are sealed as indicated. The student is given the donor copy of the form.
12. The Student may wash their hands and is then sent back to class.
13. The collector distributes the remaining copies of the form as required, being responsible for getting the appropriate copy of the form to the MRO in a timely manner.
14. The Designated Official will be notified immediately of any student who refuses to give a urine sample or is suspected of adulteration.

The MRO will review all results of urine drug testing. Any urine specimen testing positive for illicit drugs, banned substances, or adulteration will be handled in the following manner:

1. The MRO determines if any discrepancies have occurred in the Chain of Custody.
2. Depending on the substances found in the urine, if necessary the MRO will contact the parent/guardian/custodian to determine if the student is on any prescribed medication from a physician.
3. If the student is on medication, the parent/guardian/custodian will be asked to obtain a letter from the prescribing physician within five working days to document what medications the student is currently taking. Failure to provide such requested information will be considered a positive result.
4. The MRO will then determine if any of the prescribed medications resulted in the positive drug screen.
5. Finally, the MRO, based on the information given, will certify the drug test results as positive or negative and report this to the building principal. The MRO will also notify the Prevention Coordinator that a drug test returned positive giving only the dates of the collection and reporting.
   1. For example, a drug screen positive for codeine may be ruled negative by the MRO when he receives a letter from the treating physician that the student has been prescribed Tylenol© with codeine as a pain medication following tooth extraction.
   2. Or, if the student has a positive drug screen for codeine and has no documented physician order for the medication (maybe a parent gave the student one of their pills), this would likely be ruled a positive drug test by the MRO.
   3. Drug screens positive for illicit drugs (marijuana, heroin, cocaine or alcohol, etc.) would automatically be considered positive by the MRO.
6. The MRO may use quantitative results to determine if positive results on repeat tests indicate recent use of illicit or banned substances or the natural decline of levels of the illicit or banned substance from the body. If the MRO feels the quantitative levels determined to be above the established cutoffs do not reflect current use but natural decay, then a negative result may be reported.

9. PICK-UP PROCESS

The Vendor is responsible for seeing that specimens are delivered to or picked up by the testing laboratory and the Chain of Custody form properly annotated.

 

10. PROCEDURES IN THE EVENT OF A POSITIVE RESULT

a. Whenever a student’s test result indicates the presence of illegal drugs or banned substances or adulteration, the following will occur after the MRO notifies the parent:

1. The building principal, within 24 hours, will notify the parent/guardian/custodian first, then the student and Designated Official of any positive results. A written notification from the building principal, by form letter, will be sent to the parent/guardian/custodian by certified mail. The building principal may keep all test results for a period up to two years or 30 days after the student graduates, whichever is shorter.
2. The student will be notified and be required to submit to five periodical urine tests throughout the next 12-month period at their own expense to retain activity participation eligibility.
3. If the parent/guardian/custodian or student wishes to contest the results, the Vendor will arrange for the split portion of the specimen to be submitted to another laboratory approved by the Board of Education for testing. This is done at parent/guardian/custodian or student expense. Such a request must be made to the building principal in writing within five working days from first notification of positive test results.
4. The MRO may use quantitative results to determine if positive results on repeat testing indicate recent use of illicit or banned substances or the natural decline of levels of the illicit or banned substance from the body. If the MRO feels the quantitative levels determined to be above the established cutoffs do not reflect current use but natural decay, then a negative result may be reported.

A positive result from the MRO or an altered sample will constitute a first positive. The student participant will be ineligible for next 20% of scheduled competitions/performances or remainder of season (which ever is shorter) in each KSHSAA activity they are currently involved in, or in the next activity in which they plan to participate. The specific coach or sponsors individual team/group policy may supersede the requirements of this policy based on prior behavior, but can not be less than the provisions of this paragraph. Additionally, student participants who have a first positive result will be required to submit to five follow-up drug tests during the next twelve (12) month period and will be required to participate in a chemical assessment program to determine the extent of their drug/alcohol use. The cost of the follow up drug tests and chemical assessment will be the responsibility of the student or student’s parents or guardian if under age 18.

 

Second Positive Result

A second positive result by MRO ruling or adulteration will result in the student participant being declared ineligible from all KSHSAA sponsored extracurricular activities as defined in this policy in which he/she is currently participating and denied participation in future KSHSAA sponsored extracurricular activities for a period of 18 weeks, when school is in session (weeks during summer would not apply, so these 18 weeks can carry over into the next school year). In addition, the student must complete a comprehensive substance abuse program recommended by a certified substance abuse professional. The student will continue or repeat the five necessary follow-up drug screens. The cost of the substance abuse program and follow up drug tests will be the responsibility of the student or student’s parent or guardian if under age 18.

 

Third Positive Result

A third positive result will result in the student participant being barred from participation in any KSHSAA sponsored extracurricular activities as defined in this policy for a minimum of one calendar year. In addition, the student must participate in a chemical assessment program and successfully complete a substance abuse program recommended by a certified substance abuse professional at the expense of he student or student’s parents or guardian (The substance abuse program can not be the same program for the Second Positive Result). At the end of the one calendar year and successful completion of the substance abuse program, the student must complete another drug screen at the student’s expense, with negative results. Upon return to participation in KSHSAA sponsored extracurricular activities, the student will continue or repeat the five necessary follow-up drug screens at their own expense. The period of exclusion from extracurricular activities may continue into the following school year.

 

Additional Positive Result After 3rd Positive

If a student participant would have additional positive results by MRO ruling or adulteration, that student would be barred from participation in KSHSSA sponsored extracurricular activities for an additional one calendar year for each positive result.

Una conmoción cerebral relacionada con los deportes es una lesión cerebral traumática causada por un golpe directo en la cabeza, el cuello o el cuerpo que resulta en una fuerza impulsiva que se transmite al cerebro y que ocurre en los deportes y actividades relacionadas con el ejercicio. Los síntomas y signos pueden presentarse inmediatamente o evolucionar en cuestión de minutos o días. Las conmociones cerebrales relacionadas con los deportes comúnmente se resuelven en unos días, pero pueden prolongarse. Todas las conmociones cerebrales son potencialmente graves y pueden provocar complicaciones, incluido daño cerebral prolongado y la muerte, si no se reconocen y tratan adecuadamente. Si un estudiante informa algún síntoma de conmoción cerebral, o si usted mismo nota los síntomas o signos de una conmoción cerebral, busque atención médica de inmediato.

 

Los síntomas pueden incluir uno o más de las siguientes:

• Dolor de cabeza/“Presión en la cabeza”
• Nausea o vomito
• Dolor en el cuello
• Problemas de balance o mareos
• Visión borrosa, doble, o confusa
• Sensibilidad a la luz o ruido
• Se siente débil o somnoliento
• Se siente confuso o mareado
• Somnoliento

• Cambian los patrones del sueño

• “No se siente bien”

• Nerviosismo inexplicable, ansiedad, irritabilidad, tristeza

• Confusión

• Problemas de concentración o memoria (olvida las tareas deportivas)

• Repetir la misma pregunta/comentario

Nosotros/Yo entiendo que mi/nuestro estudiante puede resultar lesionado al participar en actividades, prácticas de deportes inter escolares o concursos y/o excursiones como Estudiante de la Escuela Secundaria o Preparatoria McPherson. Se sabe que las lesiones causadas por deportes inter escolares van desde un leve hematoma o rasguño hasta fracturas, lesiones a dientes, mandíbulas, torceduras o esguinces, cortadas que necesitan sutura, desgarre de ligamentos, lesiones de cabeza que pueden causar daño cerebral o parálisis, lesiones de la columna vertebral que pueden causar cuadriplejia y/u otras lesiones que pueden provocar incluso la muerte.

 

Sabemos que la participación en actividades deportivas requiere la aceptación del riesgo de una posible lesión y que el jugador puede hacer el juego más seguro para todos al no utilizar intencionalmente técnicas que son consideradas ilegales y que puedan provocar lesiones serias a ellos o a terceros. También sabemos que, el padre/estudiante son responsables de cualquier gasto médico que pueda incurrir de cualquier lesión. El distrito escolar no cuenta con un seguro para cubrir los gastos médicos iniciales para estudiantes lesionados en accidentes ocurridos mientras participaban en actividades académicas. A través de KSHSAA, el distrito compra una póliza de seguro médico por riesgos catastróficos para estudiantes que participen en programas de actividades inter escolares para cubrir los costos médicos excesivos. Esta póliza tiene un deducible de $25,000 y paga una cantidad limitada de costos no cubiertos por pólizas de seguros primarias. Para obtener más información, contacte a KSHSAA (1-785-273-5329) o a la Escuela Preparatoria McPherson.

 

Con el conocimiento de la información anterior, nosotros/yo permito que nuestro estudiante participe en actividades, programas atléticos y/o excursiones de la Escuela Secundaria y Preparatoria McPherson durante el año escolar actual.

 

Se esperan ciertos estándares de comportamiento social de todos los estudiantes. Sin embargo, ya que los estudiantes que participan en actividades atléticas y en excursiones representan visiblemente más a su escuela y comunidad, se espera que cumplan con mayores estándares de conducta y disciplina. Las siguientes reglas aplican para todos los estudiantes que participen en actividades atléticas, actividades o excursiones de la Escuela Secundaria y Preparatoria McPherson.

LEA EL ACUERDO DE CONSENTIMIENTO INFORMADO A CONTINUACIÓN. PARA PARTICIPAR EN LAS ACTIVIDADES DE KSHSAA, EL ESTUDIANTE/PADRE DEBERÁ FIRMAR ANTES DE LA PARTICIPACIÓN, O HASTA OCTUBRE, LO QUE SUCEDA PRIMERO.

 

Por medio de la presente otorgamos nuestro consentimiento para permitir que al estudiante antes mencionado al inicio de este formulario se le haga un análisis de orina para detectar la presencia de drogas ilícitas o sustancias no permitidas de acuerdo con la Política de Análisis de Drogas Hecho al Azar para Estudiantes de USD 148 Involucrados en Actividades KSHSAA de Grados del 7-12 (la política puede ser leída en línea en www.mcpherson.com) homologado por el Consejo Escolar del Distrito Escolar Unificado McPherson. Entendemos que un proveedor calificado llevará a cabo el proceso de recolección de muestras. Entendemos que cualquier muestra de orina será enviada únicamente a un laboratorio médico certificado para su análisis, y que las muestras serán codificadas con fines de confidencialidad.

 

Por medio de la presente otorgamos nuestro consentimiento para que el proveedor de salud seleccionado por el Consejo Escolar de McPherson USD 418, sus laboratorios, médicos, empleados, o agentes, junto con cualquier clínica, hospital, o laboratorio designado por el proveedor de salud seleccionado lleven a cabo un análisis de orina para detectar drogas ilícitas o sustancias prohibidas.

 

Además, otorgamos permiso para que el proveedor de salud seleccionado por el Consejo Escolar de McPherson USD 418, sus médicos, empleados, o agentes, divulguen todos los resultados de las pruebas al Oficial de Revisión Médica (MRO por sus siglas en inglés) que se encuentre trabajando para el proveedor de salud. Entendemos que los resultados serán remitidos al Director de la Institución y que también estarán disponibles para nosotros. Entendemos que el consentimiento de acuerdo a el presente Acuerdo de Consentimiento Informado tendrá efecto y aplicará para todas las actividades definidas en las normas del consejo escolar en las que el estudiante pueda participar durante el año académico.

 

COMO ESTUDIANTE: