The Principal,

Apeejay International School, Greater Noida.

Parent’s Consent-cum-Undertaking Form

Vipin Kumar
I ________________________ Tripathi
________________________ father/mother/Legal guardian of
Harshita Tripathi
Master / Miss ________________________, XII and section _____
student of class _____ A do hereby
give my consent and permission to my ward to attend the School physically.

I agree and undertake that in addition to precautions and necessary arrangements taken by the
School, my ward will ensure and follow the necessary safety precautions in and outside the
School premises, as per applicable Government order, policies and guidelines in this regard, to
contain the spread of corona virus, and also as stated herein below:

• To mandatorily wear the Face Mask / Face Mask along with shield, and use Hand
Sanitizer/Hand Wash during presence in School at all times
• To carry own water bottle and food and not to share the same with other class students
• To always maintain physical / social distancing, in and outside the School premises as
well as at the entry and exit points
• To not attend the School in case of sickness or ill health or symptoms such as cold, cough
and/or fever.
• To immediately inform the teacher / concerned staff at the School if any member at home
is sick and not to attend the School for the duration as prescribed by the doctor.
• To occupy the seat allocated in the class by the teacher and to follow all instructions /
guidelines as issued from time to time.

I confirm that my ward is medically fit to attend the school and I shall immediately stop sending
my ward to school if my ward or anyone at home has indifferent health.

Further, I undertake that I am aware of the current prevailing COVID 19 situation and the risks
associated therewith and the School authorities shall not in any way be held responsible/liable for
my ward’s health under any circumstances.

In case my ward shows symptoms like fever, cough, cold etc in school, I may be informed at my
9310464411
emergency contact number…………………….………………… and I will immediately take my
ward home.

18 August , 2021
Date: __________________

Signature: ___________________ Father

Relation : ___________________
 Daily Checklist: for physical attendance of classes in School (to be submitted every
morning, on a daily basis by the Parent/Guardian to the School, via whatsapp / email)

Harshita Tripathi
Name of student…………………………………… XII Section ………
Class ………. A

SNo. Actions taken in the morning, before sending the child to School
1. The temperature reading of my ward in the morning is normal and he/she does not have
fever.

2. My ward does not have cough.

3. My ward does not have cold.

4. My ward does not have a sore throat or any other signs of illness like diarrhea, severe
headache, vomiting or body aches.

5. My ward or anyone in our household have not had an exposure/close contact to a

COVID-19 positive case in the past 14 days.

6. My ward or anyone in our household, have not travelled/visited out of town in the past
14 days.

Vipin Kumar Tripathi

Name of Parent/Guardian ……………………

Date : 27 August , 2021