CHRIST LUTHERANSCHOOL -  NORFOLK, NEBRASKA

PARENT RECEIPT FORM

CONCERNING DRUG FREEPOLICY

THIS RECEIPT SHALL SERVE TODEMONSTRATE THAT YOU AS PARENT OR GUARDIAN OF A STUDENT ATTENDING CHRISTLUTHERAN SCHOOL HAVE RECEIVED NOTICE OF THE STANDARDS OF CONDUCT OF THIS SCHOOLEXACTED OF STUDENTS CONCERNING THE ABSOLUTE PROHIBITION AGAINST THE UNLAWFULPOSSESSION, USE, OR DISTRIBUTION OF ILLICIT DRUGS AND ALCOHOL ON SCHOOLPREMISES OR AS A PART OF ANY OF THE SCHOOL’S ACTIVITIES AS DESCRIBED INBOARD POLICY OR ADMINISTRATIVE REGULATION.  THIS NOTICE IS BEING PROVIDED TO YOU PURSUANT TO P.L.1-1-226 AND 34 C.F.R. PART 86, BOTH FEDERAL LEGAL REQUIREMENTS.  YOUR SIGNATURE ON THIS RECEIPTACKNOWLEDGES THAT YOU AND YOUR CHILD OR CHILDREN WHO ARE STUDENTS ATTENDING THISSCHOOL FULLY UNDERSTAND THE SCHOOL’S POSITION ABSOLUTELY PROHIBITING THEUNLAWFUL POSSESSION, USE, OR DISTRIBUTION OF ILLICIT DRUGS AND ALCOHOL ONSCHOOL PREMISES OR AS A PART OF THE SCHOOL’S ACTIVITIES AS HEREIN ABOVEDESCRIBED AND THAT COMPLIANCE WITH THESE STANDARDS CAN AND WILL RESULT INPUNITIVE MEASURES BEING TAKEN AGAINST ANY STUDENT FAILING TO COMPLY WITH THESESTANDARDS.

DATED THE   _____   DAY OF _________, 200___

STUDENT(S) NAME                                  GRADE

__________________________________            _____

__________________________________            _____

__________________________________            _____

__________________________________            _____

__________________________________________

Parent’sSignature