Off.

2541266
Resi. 2541379

St. Joseph’s Convent Senior Secondary School

IDGAH HILLS, BHOPAL
Date: 01.09.2021

CONSENT FORM FOR PHYSICAL PRESENCE OF STUDENTS IN SCHOOL

Dear Parents/Guardians,

As we have been asked by Education Department to Re-open the School, May I request
you to submit an undertaking in the name of your daughter that you will assume
complete responsibility for any undue situation and untoward incident she will indulge
in. you will not hold school authorities responsible. You are also requested to make safe
and secure conveyance arrangement for your daughter to and from the school. I
assure you of the safety measures of the students with in the campus. I would appreciate
if you instruct your daughter to adhere to all the rules and instructions of the school.

Student’s Name : AKSHIKA VERMA (NO)

……………………………………………………………………..

Roll Number : 7 / SEVEN

………………………

Class : 9TH
………………………… ‘A’
Section ………………………………

MR. SANJAY VERMA

I, ……………………………………………………. (Name-Parents/Guardian) give consent
to my daughter to come to the school, being aware of the current COVID-19 pandemic
around the entire Bhopal and the dangers involved. I agree to all that is given above
and I will give complete support and cooperation for the above.

Signature of Parent/Guardian : MONIKA VERMA

…………………………………………………………..

Name of Parent/Guardian :
MONIKA VERMA / SANJAY VERMA
……………………………………………………………

Mobile Number :
9039541555 / 9893434143
……………………………………………………………

Place - BHOPAL
Date –
30/12/21
AKSHIKA VERMA
_______________________
(Signature of student)

Note:-After having filled the above format, kindly bring a printed copy on the 1st day of your school.