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Declaration by the Student

I ………………………………………………….., Roll Number ………………………… Department …………………………………, student of Indian Institute of Technology Kanpur do hereby declare on this day ………… month ………….. year ……………. The following: a) That I shall always follow the instructions of the tour coordinator/supervisor deputed by the institute. b) That I shall maintain discipline/harmonious relations at all times. However, I also undertake to face disciplinary action, if found to be involved in any act of indiscipline. c) That I shall not involve myself in activity which is punishable under court of law. d) That institute shall not be held responsible for any untoward incident that occurs due to natural calamity or arising out of any other reason, whatsoever happened to me during that tour.

Signature of Student

I hereby fully endorse the declaration made by my child/ward.

Date:

Signature of Mother/Father or Guardian