Fillable Drug-Testing Consent NCAA Division III For: Student-athletes. Action: (Luther College)

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Drug-Testing Consent NCAA Division III For: Student-athletes. Action: (Luther College)

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Form 20-3f Academic Year 2020-21
Drug-Testing Consent − NCAA Division III
For: Student-athletes.
Action: Sign and return to your director of athletics.
Due date: Before your institution's first competition.
Required by: NCAA Constitution 3.2.4.6 and NCAA Division III Bylaw 14.1.4.
Purpose: To assist in certifying eligibility.
Effective date: This consent form shall be effective from the date this document is signed and shall
remain effective until a subsequent Drug-Testing Consent Form is executed.
Requirement to Sign Drug-Testing Consent Form.
Name of student-athlete: _____________________________ Sport(s): __________________________
You must sign this form prior to competition in intercollegiate athletics per Constitution 3.2.4.6 and
Bylaw 14.1.4. If you have any questions, you should discuss them with your director of athletics.
Consent to Testing.
You agree to allow the NCAA to test you in relation to any participation by you in any NCAA championship
and in any postseason football game for drugs in the banned drug classes listed in Bylaw 31.2.3.1 (see
attached). Examples of drugs in each class can be found at www.ncaa.org/drugtesting
. Note: There is no
complete list of banned substances. Check Drug Free Sport AXIS at 877-202-0769 or www.dfsaxis.com
(Organization: NCAA Division III; password: ncaa3) for questions about supplements, medications and
banned drugs.
Consequences for a Positive Drug Test.
By signing this form, you affirm that you are aware of the NCAA drug-testing program, which provides:
1. A student-athlete who tests positive for an NCAA banned drug will be declared ineligible (unless
a medical exception is granted);
2. A student-athlete who tests positive for the use of a substance in a banned drug class other than
cannabinoids and narcotics shall be withheld from competition in all sports for 365 days from the
drug-test collection date and shall lose a year of eligibility. A student-athlete who tests positive for
the use of a substance in the banned drug classes cannabinoids or narcotics shall be immediately
declared ineligible and be withheld from competition for the next 50 percent of a season in all sports
(50 percent of all contests or dates of competition in the season following the positive test);
3. A student-athlete who tests positive has an opportunity to appeal the sanction;
4. A student-athlete who tests positive a second time for the use of any substance in a banned drug
class other than cannabinoids and narcotics shall lose all remaining regular season and postseason
eligibility in all sports. A student-athlete who tests positive a second time for the use of a substance
in the drug classes cannabinoids or narcotics shall be withheld from competition for 365 days from
the date of the test and shall lose a year of eligibility. A student-athlete who tests positive for the
use of a substance in the drug classes cannabinoids and narcotics for the first time after having
tested positive for the use of any substance in a banned drug other than cannabinoids and narcotics
shall be ineligible for competition for 50 percent of a season in all sports (the first 50 percent of
regular season contests or dates of competition in the season following the positive test);
5. The penalty for missing a scheduled drug test is the same as the penalty for testing positive for the
use of a substance in a banned drug class other than cannabinoids and narcotics;
Drug Testing Concent – NCAA Division III
Form 19-3f
Page No. 2
_________
6. A student-athlete who is found to have tampered with an NCAA drug test sample shall be charged
with the loss of a minimum of two seasons of competition in all sports and shall remain ineligible
for all regular season and postseason competition during the time period ending two calendar years
(i.e., 730 days) from the date of the test; and
7. If a student-athlete transfers to a non-NCAA institution while ineligible because of a positive
NCAA drug test and competes in collegiate competition within the prescribed penalty at a non-
NCAA institution, the student-athlete will be ineligible for all NCAA regular season and postseason
competition until the student-athlete does not compete in collegiate competition for the entirety of
the prescribed penalty.
Signatures.
By signing below, I consent:
1. To be tested by the NCAA in accordance with NCAA drug-testing policy, which provides among
other things that:
a. I will be notified of selection to be tested;
b. I must appear for NCAA testing or be sanctioned for a positive drug test; and
c. My urine sample collection will be observed by a person of my same gender;
2. To accept the consequences of a positive drug test or a breach of drug testing protocol;
3. To allow my drug test sample to be used by the NCAA drug testing laboratories for research
purposes to improve drug testing detection; and
4. To allow disclosure of my drug testing results only for purposes related to eligibility for
participation in NCAA competition.
I understand that if I sign this statement falsely or erroneously, I violate NCAA legislation on
ethical conduct and will jeopardize my eligibility.
Date Signature of student-athlete
Date Signature of parent (if student-athlete is a minor)
Name (please print) Date of birth Age
Home address (street, city, state and zip code)
What to do with this form: Sign and return it to your director of athletics before your institution's first
competition. This form is to be kept at the institution for six years.
Drug Testing Concent – NCAA Division III
Form 19-3f
Page No. 3
_________
2020-21 NCAA Banned Substances
NCAA Division I Bylaw 12 and NCAA Divisions II and III Bylaw 14 require that schools provide
drug education to all student-athletes. The athletics director or athletics director's designee shall
disseminate the list of banned-drug classes to all student-athletes and educate them about products that
might contain banned drugs. All student-athletes are to be notified the list may change during the
academic year and that updates may be found on the NCAA website (ncaa.org); and informed of the
appropriate athletics department procedures for disseminating updates to the list. It is the student-
athlete's responsibility to check with the appropriate or designated athletics staff before using any
substance.
The NCAA bans the following drug classes:
1. Stimulants.
2. Anabolic agents.
3. Alcohol and beta blockers (banned for rifle only).
4. Diuretics and masking agents.
5. Narcotics.
6. Cannabinoids.
7. Peptide hormones, growth factors, related substances and mimetics.
8. Hormone and metabolic modulators.
9. Beta-2 agonists.
Note: Any substance chemically/pharmacologically related to all classes listed above and with no
current approval by any governmental regulatory health authority for human therapeutic use (e.g.,
drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved
only for veterinary use) is also banned. The institution and the student-athlete shall be held
accountable for all drugs within the banned-drug class regardless of whether they have been
specifically identified. Examples of substances under each class can be found at ncaa.org/drugtesting.
There is no complete list of banned substances.
Substances and Methods Subject to Restrictions:
1. Blood and gene doping.
2. Local anesthetics (permitted under some conditions).
3. Manipulation of urine samples.
4. Beta-2 agonists (permitted only by inhalation with prescription).
5. Tampering of urine samples.
Drug Testing Concent – NCAA Division III
Form 19-3f
Page No. 4
_________
NCAA Nutritional/Dietary Supplements:
Before consuming any nutritional/dietary supplement product, review the product and its label with
your athletics department staff. Many nutritional/dietary supplements are contaminated with
banned substances not listed on the label.
1. Nutritional/dietary supplements, including vitamins and minerals, are not well-regulated and
may cause a positive drug test.
2. Student-athletes have tested positive and lost their eligibility using nutritional/dietary
supplements.
3. Any product containing a nutritional/dietary supplement ingredient is taken at your own risk.
Athletics department staff should provide guidance to student-athletes about supplement use,
including a directive to have any product checked by qualified staff members before consuming. The
NCAA subscribes only to Drug Free Sport AXIS
TM
for authoritative review of label ingredients in
medications and nutritional/dietary supplements. Contact the Drug Free Sport AXIS at 877-202-0769
or dfsaxis.com (password ncaa1, ncaa2 or ncaa3).
Drug Testing Concent – NCAA Division III
Form 19-3f
Page No. 5
_________
THERE IS NO COMPLETE LIST OF BANNED SUBSTANCES.
Do not rely on this list to rule out any label ingredient.
Drug Classes Some Examples of Substances in Each Class
Stimulants
Amphetamine (Adderall)
Caffeine (Guarana)
Cocaine
Dimethylbutylamine (DMBA; AMP)
Dimethylhexylamine (DMHA; Octodrine)
Ephedrine
Heptaminol
Hordenine
Methamphetamine
Methylhexanamine (DMAA; Forthane)
Methylphenidate (Ritalin)
Mephedrone (bath salts)
Modafinil
Octopamine
Phenethylamines (PEAs)
Phentermine
Synephrine (bitter orange)
Exceptions: Phenylephrine and Pseudoephedrine are not banned.
Anabolic Agents
Androstenedione
Boldenone
Clenbuterol
DHCMT (Oral Turinabol)
DHEA (7-Keto)
Drostanolone
Epitrenbolone
Etiocholanolone
Methandienone
Methasterone
Nandrolone
Norandrostenedione
Oxandrolone
SARMS [Ligandrol (LGD-4033); Ostarine; RAD140; S-23]
Stanozolol
Stenbolone
Testosterone
Trenbolone
Alcohol and Beta Blockers
(banned for rifle only)
Alcohol
Atenolol
Metoprolol
Nadolol
Pindolol
Propranolol
Timolol
Diuretics and Masking
Agents
Bumetanide
Chlorothiazide
Furosemide
Hydrochlorothiazide
Probenecid
Spironolactone (canrenone)
Triameterene
Trichlormethiazide
Exceptions: Finasteride is not banned.
Narcotics
Buprenorphine
Dextromoramide
Diamorphine (heroin)
Fentanyl, and its derivatives
Hydrocodone
Hydromorphone
Methadone
Morphine
Nicomorphine
Oxycodone
Oxymorphone
Pentazocine
Pethidine
Cannabinoids
Marijuana
Synthetic cannabinoids (Spice; K2; JWH-018; JWH-073)
Tetrahydrocannabinol (THC)
Peptide Hormones, growth
factors, related substances
and mimetics
Growth hormone (hGH)
Human Chorionic Gonadotropin (hCG)
Erythropoietin (EPO)
IGF-1 (colostrum; deer antler velvet)
Ibutamoren (MK-677)
Exceptions: Insulin, Synthroid and Forteo are not banned.
Hormone and Metabolic
Modulators
Aromatase Inhibitors [Anastrozole (Arimidex); ATD (androstatrienedione); Formestane; Letrozole]
Clomiphene (Clomid)
Fulvestrant
GW1516 (Cardarine; Endurobol)
SERMS [Raloxifene (Evista); Tamoxifen (Nolvadex)]
Drug Testing Concent – NCAA Division III
Form 19-3f
Page No. 6
_________
NCAA/05_11_2020/KP:gmd
Beta-2 Agonists
Bambuterol
Formoterol
Higenamine
Norcoclaurine
Salbutamol
Salmeterol
Any substance that is chemically related to one of the above classes, even if it is not listed as an example, is also banned.
It is your responsibility to check with the appropriate or designated athletics staff before using any substance. Many nutritional/dietary
supplements are contaminated with banned substances not listed on the label.
Information about ingredients in medications and nutritional/dietary supplements can be obtained by contacting Drug Free Sport AXIS at
877-202-0769 or dfsaxis.com
(password ncaa1, ncaa2 or ncaa3).
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Completed 22 August 2020

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