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Glenbard Township High School District 87
Policy 7:190-E1

Students

Exhibit – Referral for Breathalyzer Testing

I understand that I have been referred for breathalyzer testing to detect alcohol use. This referral is based on the following:

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I agree to submit to the test, and have the results shared with District Administrators.



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Student Signature                                                                                       Date


_________________________________________________________________________________________
Witness Signature                                                                                       Date

I do not agree to submit to breathalyzer testing. I understand that my refusal to participate in such testing may be considered evidence that I am under the influence of alcohol or another prohibited substance.

_________________________________________________________________________________________
Student Signature                                                                                       Date


_________________________________________________________________________________________
Witness Signature                                                                                       Date


ADOPTED:   April 3, 2006

REVIEWED: May 15, 2006