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CONSENT FORM(Partial resumpiion in activities in schoo!s fcr the students of class 9t +o 12tn on a voiuntary

basis for taking guiCance and counseiling from the teachers.)

To,

The Principal/ Head Master

(Name cf tl're school)

CONSENT

l/we, Smti mother

And/Or

anci parents of ................. ........ (Name of the student) studying in

c1ass................ Section having Roll No...............

in

(Name

.... (address of the school) , hereby give my/our consent to allow my school going s9n/daughter toattend the partial resumption in activities in schools for the students of class 9th to 12th, w.e.f 21't

September,2020, on a voluntary basis for taking guidance and counselling from the teachers.

l/We, am/are aware of the Covid 19 pandemic and its symptomatic & safety protocols and

assure that my son/daughter will obey and observe ail the Covid-19 safety protocols as per the

insiructions of the school authorities and Health authorities, based on the guidelines issued vide

Order No.ASE.01/20201Pt-ll/1,8 dated, Dispur the .16th September, 2O2O and Order

No.ASE.01/20?O/Pt-ll/19 dated, Dispur the L8th September, 2020.

The above informotion is true to my knowledge and I shall be liable for punishment or panel

action os per Rules if the information lurnished by me is found to be false or fabricated in ony nature

at any point of time.

Full Signature of Mother

And/Or

Full signature of father.

Contact Number if any :

N.B. : 7. One Consent Form for one student. 2. Signoture o! both Mother ond Father preferoble however eithier of the' signoture shall also be occeptoble. 3. Residential should motch the odmission Form oddress. 4, This is a purely

theof