DRUG TESTING CONSENT FORM As an enrolled student/parent of the College, I understand that the use of drugs, alcohol, and other controlled substances creates a safety concern for all students and employees. In the interest of creating a safe learning environment, I hereby give my consent for ACES POLYTECHNIC COLLEGE, INC. (APCID to conduct mandatory drug tests it considers necessary. I understand that this test is in compliance with Republic Act No. 9165, otherwise known as the “Comprehensive Dangerous Act of 2002”, the General Guidelines for the Conduct of Random Drug Testing for Secondary, Tertiary Students, and pursuant to CHED CMO No. 25, Series of 2009. It is the policy of the College to safeguard its students against the ill effects of dangerous drugs and to maintain a drug-free environment. To obtain such objectives, APCI shall conduct the required mandatory drug testing for tertiary students primarily for prevention and rehabilitation in compliance with to Section 36 of Republic Act No. 9165. I fully understand that as a student/parent, I/my child will be subject to the mandatory drug test ‘My signature hereon serves as student/parental consent: a) For me/my child to undergo mandatory drug testing and to submit a urine sample for that purpose; b) For me/my child to undergo mandatory drug testing in accordance with Republic Act No. 9165, otherwise known as the “Comprehensive Dangerous Act of 2002”, the General Guidelines for the Conduct of Random Drug Testing for Secondary, Tertiary Students, and pursuant to CHED CMO No. 25, Series of 2009. ©) For ACES Polytechnic College, Inc. (APCI) to submit my child’s urine sample for testing for drugs prohibited by its policy; and, 4) For ACES Polytechnic College, Inc. (APCI) to obtain the results of my child’s drug test from ICJE Mentors for use in accordance with the Mandatory Drug Testing Policy. I release ACES Polytechnic College; Inc. (APCI) from any liabilities, claims, and causes of action, known or unknown, contingent or fixed, that may result from these tests. Signature over Printed Name (Student) Date ‘Signature over Printed Name (Parent/Guardian) Date Non-Diserimination: The (Name of Recipient) does not discriminate on the basia of race, color, national origin, sex, disability, or ‘age in ite programa and activitin. The following person has boon designated to handle inquiries regarding the non-diecrimination policies: Name and/or Title: Ma, Madel G. Baay, RCrim, LPT and Mr. Ajun B. Razul, RCrimSO2 Designation: ICJE Faulty ‘Telephone No.: 09708780782ACES POLYTECHNIC COLLEGE, INC. ‘© x009 Tagum Panabo Circumferential Rd, San Francisco, Panabo City, ‘Davao del Nore, Philippines CONSENT TO PARTICIPATION IN MANDATORY STUDENT DRUG TESTING PROGRAM Ihave read and understand the policy governing INSTITUTE OF CRIMINAL JUSTICE EDUCATION’s Mandatory Drug Testing Program. | hereby consent to submit to a drug test and to furnish a sample of my urine for analysis, as shall be determined by ICJE in order to meet with their policy. | understand that as a condition to enrol in 2 semester S.Y. 2022 - 2023 and as a condition to participation in extracurricular programs, | must participate in the drug testing program. | understand that my failure to pass the drug test may result in disciplinary action, pending, expulsions from this institution, or may require me to participate in a rehabilitation program to the discretion of the Institution. | hereby release, indemnity, and hold harmless the Institution, its employees, and administrators from any liabilty, loss, or expenses, injury, damage, or claims whatsoever on or about this drug test. understand that all information disclosed by and acquired by the institution as derived from this test shall be kept confidential and shall solely be used for the purpose described herein. ‘Student's Name and Signature: ‘Student ID # Parent/Guardian: Name and Signature Date “Giving More forthe Less" “Brau of immigration Roereived ‘Authority to Accept Foreign Stents ‘RAPS No, RO-2011-028" ‘Deparment of Education