Form Owner: vinashcoaching.com

VinAsh Coaching, LLC Voluntary Substance Screening Support and Prevention Program at MCHS

Adolescent alcohol and drug use is a major concern for both educators and parents. The use of illegal substances can lead to harmful and even disastrous results for everyone involved. It is, therefore, important to empower students and parents to avoid the pitfalls associated with drug and alcohol use.

To assist interested families in achieving this goal, MBUSD facilitates a voluntary substance abuse testing program through Vin’Ash Coaching, LLC, an independent contractor, on the Mira Costa campus.

Students who participate will, on a random basis, be selected to undergo a voluntary drug test. The tests will be administered on campus during the school day in a private and secure location. All tests will be conducted by trained professionals of Vin’Ash Coaching, LLC.

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I (the parent/guardian) hereby give consent for child to participate in the voluntary drug testing program at Mira Costa High School. I understand the Manhattan Beach Unified School District (“District”) (collectively hereinafter “District”), contracts with Vin’Ash Coaching, LLC (“Provider”) to perform all testing and counseling services associated with the program and I give both the District and Provider, permission to communicate information, as necessary to conduct drug testing on my child. I understand that Provider will not communicate the results of the test(s) to any other party without my written consent, including to the school. I authorize Provider to collect urine samples from my child and perform analysis on such fluids consistent with substance screening practices. Upon any presumed positive result, I give Provider consent to send the sample and participant identifier information to a certified lab of its choice for further testing and confirmation of results. I understand drug testing will take place at my child’s school during class hours. The cost for the program is $135 and includes four drug testing attempts, any necessary lab confirmation, and all referral and support services offered by Provider's certified drug and alcohol counselors. Provider, periodically and randomly, attempts to collect samples from participants throughout the school year. Attempts are consider made if a child is called out of class to perform regardless of their ability to perform. At anytime, I may withdrawal my child from the voluntary drug testing program by providing written notice to the District, however, I understand this will forfeit any unused services and no refund will be issued.

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Disclaimer: Excluding legally mandatory reporting obligations, all information collected by Vin’Ash Coaching, LLC while performing duties in connection with the voluntary drug testing program at Mira Costa High School is confidential. Vin’Ash Coaching, LLC conducts testing services on school property and requires the assistance by school personnel to perform drug screening. Excluding permissions mentioned herein, at no time will any information be released to the school, or any other person, entity or agency without prior written consent of the child’s parent or legal guardian. The school does not take any punitive action on any student for their enrollment or participation in the voluntary drug testing program. The services offered by Vin’Ash Coaching, LLC, are designed to decrease adolescent alcohol and drug use, while increasing parent awareness about what their children are doing. Vin’Ash Coaching, LLC reserves the right to report to any person, entity, or agency, any testing result collected, provided that all personal information of participants’ is omitted from such reports.


Student 1

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I (the student) hereby give my consent to participate in the voluntary drug testing program at Mira Costa High School. I understand that I may be called out of class periodically with no prior warning. I will be required to provide urine samples for screening. I may be required to empty my pockets and stow any items not permissible in the screening area. I give consent for Vin’Ash Coaching, LLC to provide any and all results to my parent/guardian via email or by telephone communication.

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Student 2 (if applicible)



I (the student) hereby give my consent to participate in the voluntary drug testing program at Mira Costa High School. I understand that I may be called out of class periodically with no prior warning. I will be required to provide urine samples for screening. I may be required to empty my pockets and stow any items not permissible in the screening area. I give consent for Vin’Ash Coaching, LLC to provide any and all results to my parent/guardian via email or by telephone communication.



Plan Selection

The cost of the program, is $135, per student

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