Consent Statement:

I consent for My Brothers Keeper of North Carolina to perform an initial and periodical drug screening testing. I understand these drug screening testing is to hold me accountable If I pop positive at any time. I understand that I will immediately vacate the premises without a fuss or threats. I understand that all my belongings will be bagged and I will receive a call when I can come by and pick up my belongings.

I understand that I will not blame anyone for me popping positive for a drug test as I will take responsibility for my own actions. I understand that I can reapply to the program after three weeks. I understand that I can be reinstated to the program upon a negative drug test. I understand that if I am accepted a second time that if I mess up I will not be allowed to reapply to the program again for 24 months.

I, the undersigned applicant, hereby consent to participate in a drug screening test as part of the application process for residency at My Brother's Keeper of NC. I understand that this test is intended to promote a safe and healthy environment for all residents and staff. I agree to provide a sample for testing, which may be collected and analyzed by an authorized laboratory. I understand that the results of this test will be kept confidential, shared only with authorized personnel as necessary for the application and admission process. I acknowledge that a positive test result or refusal to submit to testing may affect my eligibility for residency. By checking below, I confirm that I understand and agree to these terms and voluntarily consent to the drug screening test.