This form is only for Yorktown High School Students. Please contact your school if you have questions concerning this.

All drivers must complete this form each year and pay $5.00 fee. The $5 fee will be paid to YHS prior to receiving your parking pass. You will also be required to agree to the Drug Testing Agreement below.

I agree to the terms and responsibilities stated below in connection with obtaining authorization to use the school parking lot.

I understand that the parking lot is the property of Yorktown Community Schools. I agree that the car driven by the above-named student will not be used to transport or store illegal items on school property and will not use the school parking lot to violate a criminal law or school rule.

I agree to park appropriately in the spaces provided by Yorktown Community Schools. I understand failure to do so may result in the loss of driving privileges, loss of parking permit, and/or the vehicle being towed at the driver’s own expense.

I authorize school officials and/or school security guards to seize any item that violates a criminal law or school rule or provides evidence of a criminal law or school-rule violation.

Click here to view the Drug Testing Policy, then indicate that you agree below.

We have reviewed a copy of the Yorktown Community School Corporation Drug Testing Policy and have read and understand the policy.

We desire that my student be permitted to participate in extra-curricular activities and/or drive to school, and hereby voluntarily agree to be subject to the terms of this program during the entire course of extra-curricular participation and/or permit to participate as a Student Driver, in Yorktown High School/Yorktown Middle School.

We accept the method of obtaining urine samples, testing of such specimen, and all other aspects of the program as explained in the policy. We agree that the above named student will cooperate in furnishing urine specimens whenever requested within the specifications of this policy. We further consent to the disclosure of sampling, testing, and results as explained in this policy.

The consent given pursuant to all State and Federal Privacy Statutes and is a waiver of rights to non-disclosure of such test records and results only to the extent of the disclosure in the program.

I verify that all of the information contained in this form is correct and accurate. In the event that I move from the above residence, I will notify the school and provide documentation of the new address.