__________________________________________________________________________________________________

To,

The Manager,
The Radiant Academy,
Udaipur, Rajasthan

DECLARATION CUM CONSENT

1.) I and my / our ward(s) have read, understood and gone through the guidelines and advisories issued by the Central
and State Government(s), Institute, from time to time including the Standing Operating Procedure – SOP issued by the
Office of Director, Secondary Education Rajasthan, Bikaner vide its letter क्रम ांक.-शिविर -म ध्य/म -स/विविध दििस/2018/461
dated 07.01.2021, as amended pertaining to the protection of ourselves/ our ward(s) from the spread / infection of
COVID-19 and duly understand that I/we are free to send our ward(s) to institute for attending classes or not, at our
sole discretion / choice.
2.) I and my / our ward(s) hereby acknowledging the fact that institute has taken all possible and appropriate measures to
provide a safe and secure environment to its students, staff and visitors by placing all preventative measures to reduce
the spread of COVID-19. However, since it is practically not possible for the institute to prevent all risks of infection as
this virus is still spreading, hence the institute cannot assure / guarantee us that my / our ward will not become infected
with COVID-19.
3.) In the light of above, I/we in all conscience, willingly giving consent and declaring by submitting this form that-
(A.) I/we are agreeing to send my/our ward(s) to the institute voluntarily and assuring that we and my / our ward(s) will
follow / abide by all COVID-19 protocols / guidelines stated above without any lapse; and
(B.) I and my/our ward are not residing in the Contentment Zone(s) declared by District Administration to stop the spread
/ infection of COVID-19 and/or if in future our residing area would be notified as Contentment Zone, we shall notify
the same to the institute and will not send our ward(s) to the campus of institute to attend the classes; and
(C.) I and my/our ward(s) are not suffering from any medical conditions, allergies or symptoms of Covid -19 etc. and
medically fit to attend the classes / study sessions and assuring that he/she will wear mask, keep sanitizer with
him/her, follow hygiene conditions and maintain minimum distance of 6 feet during all the time, while he/she would
be at institute.
(D.) I and my/our ward(s) have understand that every day there will be sanitisation and temperature check at the institute
gate and if our ward’s temperature is more than 100 F, he/she will be asked to sit in the isolation room under
information to us to come and take him/her home.
(E.) In case of any symptoms of COVID-19 would be detected, I/we will not send him/her to the schools or in case these
symptoms would arises in during classes at institute, institute may inform us and may notify to the certain public
health officials / local administration with a legitimate need / obligation in compliance of COVID – 19 guidelines.
I/we shall not hold the institute responsible for this and accepting our full responsibility to bear all medical and
hospital expenses and any other related expenses resulting out of it; and also undertake to not be initiate any legal
action for recovery of hospital expenses, cost, damages or any other criminal action of any nature whatsoever
against the institute, its officials and management staff.
(F.) I/we have understand and accept the fact that I/we have to submit an RTPCR negative COVID-19 test report to the
institute when our ward joins back to the institute.

Name of the student

Chitraksh Vaishnav
Student’s Class and batch
20 X first batch (evening batch)
Name of Parent / Guardian: Bhagwati prasad vaishnav
Signature of Parent / Guardian:

Date:
1st Feb 2021
Mobile No
9680975403
Emergency contact details (If different from above)
9982630183
Relation with Student
Father