TO BE PRINTED ON RS 100/- STAMP PAPER

COVID-19 INDEMNITY FORM

(This document contains 4 printed pages)

I,……………………………………………………………………………………………………….(Parent/Legal Guardian) of-

………………………………………………………………………………………………………………..(Name of the Student)

Roll No……………………………………House………………………………………………….Class……………………………..

acknowledge the contagious and unpredictable nature of the corona virus disease (COVID-19)
and I hereby voluntarily execute this COVID-19 Indemnity Form.

I understand that The Doon Girls’ School has put in place preventive measures and other
protocols to minimize the spread of COVID-19 but, even so, the Student’s return to the School
may subject them to the risk of being infected. It is however well known that the COVID virus is
ubiquitous in the atmosphere all over India. Therefore, the risk of exposure is everywhere,
whether in School or at home or in the market or anywhere else. However, The Doon Girls’
School will endeavor to maintain higher standards and keep it as a controlled entry zone so that
it offers less risk to potential exposure than any other place.

I also understand that the Student is under no obligation to attend the School if I and/or the
Student have any safety concerns.

Notwithstanding this, I have freely consented to the Student’s return to the School fully aware
of, and on the voluntary assumption of, the aforementioned risk.

I undertake to follow and to impress on the Student to follow, all instructions and requirements
of the School (as may be amended by the school from time to time) due to the School’s
response to the COVID-19 pandemic to limit any transmissions of COVID-19, and as required by
any Regulations issued by the Government under the Disaster Management Act, 2005 (Act
No.57 of 2005).

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I hereby agree to unconditionally indemnify and hold harmless The Doon Girls’ School against
any claim for damages or expenses and/or from any other claims, costs or other liability or
expense of any nature whatsoever (whether direct, consequential or otherwise for death,
illness or other loss or harm sustained by the Student), arising out of or in connection with the
transmission of COVID-19 at School.

I hereby unconditionally, waive and discharge any and all claims, suits or proceeding that I, or
the Student, may have against The Doon Girls’ School with respect to death, illness or any other
loss or harm, arising out of, resulting from, relating to or in connection with the transmission of
COVID-19 at School.

While The Doon Girls’ School will use realistic endeavours to limit Student to Student and Staff
to Student physical contact, there will be instances where contact is made between Students
while they adapt to the new guidelines and/or when Student need to be comforted and
assisted by staff. I agree that it will not be possible for the Student to guarantee that this
contact will not occur with children on site.

I understand this is an important legal document indemnifying The Doon Girls’ School against
the transmission of COVID -19 on the Student’s premises and that by signing this Indemnity, I
hereby waive any and all legal rights that may exist and that I may otherwise have against The
Doon Girls’ School and others.

NAME OF PARENT/ LEGAL GUARDIAN:……………………………………..…………………………………………………

PERMANENT ADDRESS:……………………………………………….………………………………………………………………

…………………………………………………………………………………………………………………………………………………….

PRESENT ADDRESS:………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………….

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MOBILE NO:………………………………………………………………………………………………………………………………..

TRAVEL HISTORY OF THE STUDENT (Last 3 weeks) (DOMESTIC & INTERNATIONAL):………………….

……………………………………………………………………………………………………………………………………..……………..

TRAVEL HISTORY OF THE FAMILY (Last 3 weeks) (DOMESTIC & INTERNATIONAL):…………….……….

……………………………………………………………………………………………………………………………………..……………..

HISTORY OF COVID INFECTION OF THE STUDENT:……………………………………………………………………….

…………………………………………………………………………………………………………………………………………………….

HISTORY OF COVID INFECTION OF THE FAMILY:…………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………....

ZONE OF ORIGIN: RED/YELLOW/GREEN/CONTAINMENT

I/WE DO HEREBY DECLARE AND CERTIFY THAT I/WE HAVE READ THIS DOCUMENT AND I/WE
FULLY UNDERSTAND ITS CONTENT. I AM / WE ARE AWARE THAT THIS IS AN NDEMNITY AND
RELEASE OF LIABILITY AND I / WE SIGN IT OF MY OWN FREE WILL.

Signed on Date:……………………………………(dd/mm/yyyy)

Parent/Guardian

Accepted by the School on Date:……………………………………………(dd/mm/yyyy)

Principal

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*The governing law and alternative dispute resolution provisions of the Parent Contract (as
amended from time to time) shall apply mutatis mutandis to this Indemnity.

*This Indemnity MUST be accompanied with a negative COVID test of the student.