Athletics Office
DJ Pulley
Athletic Director
WCU Box 145, 710 William Carey Parkway, Hattiesburg, MS 39401 • Office: 601-318-6048
djpulley@wmcarey.edu • www.careyathletics.com • www.wmcarey.edu
William Carey University Drug Testing Consent Form
To Student-Athletes of William Carey University
You must sign this form to participate (1.e., practice or compete) in intercollegiate athletics at William
Carey
University. Failure to sign the consent form will result in immediate rescinding of your Athletic
Grant-In-Aid
by the Director of Athletics.
Drug Testing Consent
1.
You agree to allow William Carey University to drug test you in order to participate in
intercollegiate athletics programs offered by WCU.
2.
You understand and agree that this consent and the results of your drug tests, if any, will be
disclosed to the Vice President of Student Services, the Director of Athletics, Head Coach
of your
sport, the athletic trainer, and the President of the University.
3.
You agree to disclose your drug testing results only for the purposes related to your eligibility
for
participation in regular season and post-season competition and referral for counseling and
intervention.
4.
You affirm that you understand that if you sign this statement falsely or erroneously, you
violate
the William Carey University Athletic Department policies and procedures and you
will further
jeopardize your eligibility.
5.
You understand that if you are under the age of eighteen (a minor), you must have this form
co-
signed by a parent or legal guardian.
6.
You agree to follow all criteria outlined in the William Carey University Drug Testing Policy.
___________________________________ ___________________________________________________
Date Signature of Student-Athlete
___________________________________ ___________________________________________________
Date Signature of Parent/Legal Guardian (if student-athlete is a minor)
____________________________________ ____________________________________________________
Name of Student-Athlete (PRINTED) Date of Birth
________________________________ _____________________________________________
Home Address City State Zip
______________________________________________________
Sport(s)
