Name : Mustafa Address : Sengkang, Kab. Wajo, Sulawesi Selatan As parent/ guardian of: Name of Student : Muh. Amar Almubaraqa Mustafa ID Number : 003202000012 Study Program : Mechanical Engineering Address : Sengkang, Kab. Wajo, Sulawesi Selatan Co-morbid Conditions (please √) : ☐ Yes ☐ No (If yes, please specify)
Hereby declare that:
1. I give permission to the student mentioned above to take the Online Learning in the Academic Year 2021-2022 Semester 1 that will begin on 6th September 2021. 2. I understand and I am willing to take Online Learning lectures voluntarily without coercion from President's University. 3. I understand and will accept full responsibility of the risks related to taking the Online Learning, and absolve President University from all forms of responsibility related to my decision. I hereby sign this statement consciously and without any coercion from any party Thursday, 2 September 2021
Signature:
Parent/Guardian Student
( Mustafa ) (Muh. Amar Almubaraqa Mustafa )
*Co-morbidity are existing medical conditions such as coronary disease, diabetes, high blood pressure and other illnesses that make a person highly susceptible to COVID-19 infections