Contact Us

(877) YAY-DFCA (929-3322)

10361 Spartan Dr. Cincinnati, Ohio 45215

For immediate information on Drug Free Clubs download our information packet, Contact Dave Huggins.

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Please tell us where you'd like to volunteer. (Name the school, county, address, and/or other relevant info.)
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Name of Student (Club Participant)*
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Upload a Picture for Your Card
Max. file size: 6 MB.
Student's Name*
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Student's Date of Birth (needed for verification purposes)*
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By completing this form and typing "YES" in the box below, you are giving Drug Free Clubs of America permission to send this medical information to the doctor's email so he may complete his report. You are also certifying that it is within your rights to give this permission. ----- TYPE "YES" in the box-----.*
Below are buttons to upload pictures of the necessary prescription details. In order to match a medication with a drug test, the doctor must have a picture of the patient's name, the medication's name, and the prescription's fill date (must be before the test date). Photos of this information must come from any ONE of these sources: The prescription bottle's label, a copy of your pharmacy receipt, or a letter from the pharmacy. ***NOTE: All 3 PICTURES must be from the SAME SOURCE! If your source shows all the information in one picture, upload the picture in each required field. - - -Select your source of prescription information - - -*
- Prescription bottle's label
- Screenshot of information from my pharmacy's mobile app or website
- Receipt from the purchase of the prescription
- Letter from the pharmacist
PHOTO 1 REQUIRED - PATIENT'S NAME: Upload a picture of the patient's name shown from any of these sources: 1. your prescription bottle label, or 2. a copy of your pharmacy receipt or 3. a letter from the pharmacist.*
Max. file size: 64 MB.
PHOTO 2 REQUIRED - MEDICATION'S NAME: Upload a picture of the medications's name from the same source as photo 1.*
Max. file size: 64 MB.
PHOTO 3 REQUIRED - THE PRESCRIPTION's FILL DATE - MUST BE BEFORE THE TEST DATE. Upload a picture of the date the prescription was filled from the same source as photo 1.*
Max. file size: 64 MB.
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