Purchase additional Test for member student – Drug Free Clubs of America

Looking to have your child tested at our next testing session at your school?

This is where you can have them added to the list at their schools next testing session.

Please feel out the form below and they will be added to your student’s schools next testing list.

Parent Name*
First Last
BEST Parent Email (A valid email is extremely important for communications which are often time-sensitive.. DFCA will never sell your information.)*
Student Name*
First Last
Select School*
Select Your Membership for Cooper*
- 1 Year - $35
Grade*
Student Birthdate*
Gender*
Homeroom Number (If Known)
Address*
Street Address Address Line 2 City State ZIP Code
Best Phone*
Parent Cell*
Consent: I Consent to the taking of specimens for drug screening as a part of an examination in connesction with participation in Drug Free Clubs of America and authorize the release of those results to DFCA and the above named. I understand this test will be performed at the schools next scheduled test date.*
- Yes, I am the Parent applying and I consent.
Extra Student Drug Test
Price: $20.00
Student drug test at next school testing
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00