Navrachana International School, Vadodara

Student’s Name :

Activity proposed :

Activity type (Tick) : Creativity Action Service

Starting Date : Completion Date :

Day and time of activity :

I plan to achieve (Identify some specific skills and attitudes you aim to achieve through this activity - refer to aims and objectives of CAS)

Parents approval
I have gone through the proposal form and give my permission for
to participate in the activity proposed under CAS Program. If at any stage I wish to withdraw my child from the
proposed activity, I understand, I need to inform the CAS co-ordinator in writing prior to do so.

Parent’s signature : Date :

Name of Supervisor :

I have gone through the students proposal form. I take responsibility of the student for the proposed activity as a
supervisor. I understand that I will need to evaluate student’s performance honestly and submit a written report on
the student’s involvement and performance during the activity.

Supervisor’s signature : Date :

CAS Co-ordinator’s signature : Date :

NISV Navrachana International School. Vadodara CAS JOURNAL .DIARY Name : Class of 2016-18 Activity : Date : Time : to Date : Time : to Date : Time : to Date : Time : to Date : Time : to Date : Time : to Reflections (also include learning outcomes if you have achieved any) (Use back of this sheet to stick photos or additional write up) Supervisor’s Comments Supervisor’s Signature .