Signed Statement Form

PROCEDURES SUBSEQUENT TO THE POLICY

“DRUG, TOBACCO AND ALCOHOL USE BY STUDENTS”

(Brunswick School Department Policy, File: JICH)

 

“The Brunswick School Department recognizes chemical dependency as a treatable disease which may interfere with the learning process, create interpersonal problems and cause physical and emotional suffering to the user as well as to family and close associates.  The Brunswick School Department will cooperate with effective organizations to help detect diagnoses and treat affected students.  The Brunswick School Board unequivocally endorses the philosophy that the schools should be free from the detrimental effects of illicit drugs, alcohol and tobacco.  The School Department is committed to helping to prepare students to make responsible choices about the use of chemicals and tobacco, to assist those who are at risk or affected or those who manifest signs of abuse in order that they may lead healthy, productive lives.  It is through this policy and subsequent procedures that the School Department can provide for and protect the integrity of the educational environment.  It is recognized that in order for the School Department to effectively intervene family and community involvement is crucial.  Compliance with Brunswick School Department’s standards of conduct related to substance abuse is mandatory.”  ( Brunswick School Department Policy, File: JICH).

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BRUNSWICK HIGH SCHOOL CHEMICAL ABUSE PROCEDURES

SIGNED STATEMENT (must be signed by both student and parent/guardian)

 

 

**I have read and understand the attached Chemical Abuse Procedures

& have secured my parent’s or guardian’s signature, which acknowledges their receipt of the rules.

 

 

_______________________________________________                          ___________________

Student Signature                                                                                                         Date

 

 

**I acknowledge receiving the Chemical Abuse Procedures attached to this statement.

 

_______________________________________________                          ___________________

Parent’s Signature                                                                                                        Date

 

_____________________________                                      ________________________________

Telephone Number                                                                              Parent’s E-mail Address

 

This statement must be signed and returned prior to practice or participation in any Brunswick High School Athletic or Sports Team/Activity.