Participation Agreement
Purpose. GoldStar is an interactive web-based program designed to help candidates for a High School Diploma (“Participants”) remain drug-free and find meaningful employment upon graduation by putting them in contact, throughout the course of their senior year of high school (“Senior Year”), with GoldStar affiliated businesses (“Affiliates”) looking to hire. This Participation Agreement (“Agreement”) is requisite for admission into the GoldStar Program and must be signed by a Participant and/or, if the Participant is under eighteen (18) years of age, his/her legal guardian.
Drug screening policy. As a term of participation in the GoldStar Program, the Participant and, where appropriate, his or her legal guardian, agrees to periodic urine tests for the presence or recent usage by Participant of the following substances: _____________ (the “Drug Tests”).
These Drug Tests are to be administered by a health care professional duly certified for the administration of such tests and approved by GoldStar prior to admission of the Participant to the program and at three (3) randomly selected occasions over the course of the Participant’s Senior Year. The Participant and/or legal guardian further agree to waive his/her nondisclosure and privacy rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in allowing the administering health care professional to share the results of these tests with the GoldStar Program.
Drug Test Results. Negative drug test results (i.e. test results that do not indicate the presence of drugs in Participants’ urine) are a condition of participation in the GoldStar Program. If any of the Participant’s urine analyses report the presence of drugs, and the Participant suspects that the positive result was a false positive, then a second Drug Test may be administered by a GoldStar approved health care professional, upon written request to GoldStar. All such requests must be made within five (5) business days of initial examination results. If the second test gives positive readings as to the presence of any of the drugs tested for under the terms of paragraph 2 herein, then GoldStar may remove the Participant from the program, providing the Participant with written notice of said removal.
To reduce the risks of misreading test results, a certified copy of all drug prescriptions given to the Participant over the window beginning ninety (90) days prior to the commencement of the Participant’s Senior Year and going until the Participant’s graduation must be provided to GoldStar as soon as reasonably possible.
Release of Limited Medical Records. In accordance with the statutory requirements of HIPAA, the Participant and/or its legal guardian hereby authorizes the release of Drug Test results conducted in compliance with Paragraph 2 of this Agreement to the GoldStar Program, to be shared with GoldStar-affiliated companies under the terms of Paragraph 9 of this Agreement.
Release of Limited Academic Records. In accordance with the Family Educational Rights and Privacy Act (FERPA) and the West Virginia Department of Education Data Access & Management Guidance (§126-94-15), the Participant hereby authorizes the release of the academic records described below in subparagraphs (a), (b), and (c) to the GoldStar Program, to be shared with Affiliates under the terms of Paragraph 9 of this Agreement, which records shall include and be limited to:
Quarterly Grade Point Averages
Quarterly records of absences
Quarterly records of tardiness
These records will be requested of the Participant’s school by and should be made available to the GoldStar Program upon the termination of each quarter of the Participant’s Senior Year.
Term of Agreement. The records released under Paragraphs 3, 4, and 5 of this Agreement will remain in the GoldStar Program system for twelve (12) months following the Participants’ graduation from high school or the termination of this Agreement pursuant to Paragraphs 7 and 8 herein, whichever comes sooner. Once this Agreement has been terminated, the Participant will no longer be able to access his or her account in order to communicate with any GoldStar-affiliated businesses.
Termination by Participant. The Participant may terminate this Agreement and his/her participation in the GoldStar program at any time for any reason upon written notice to GoldStar.
Termination by GoldStar. GoldStar reserves the right to terminate this Agreement and the Participant’s involvement in the GoldStar program, at any time, if a) the Participant tests positive for the presence of any of the drugs listed in Paragraph 2 herein; b) the Participant is found to have falsified any of the academic or medical records he/she reported to GoldStar; or c) the Participant or his/her legal guardian is found to have acted in bad faith in any other way relating to terms, conditions, and circumstances of this Agreement.
Confidentiality. GoldStar affirms that all medical and academic documents released to it under the terms of this Agreement will be shared only with GoldStar-affiliated companies for the sole purpose of considering recruitment of Participant for employment, and further affirms that all Affiliates have signed Confidentiality Agreements limiting their usage of this information to that same purpose.
SIGNED: