Sei sulla pagina 1di 3

CONSENT AFFIDAVIT OF PARENT/GUARDIAN

I, [insert name] (father) and I, [insert name] (mother), residents of


_________________________________________________________________,
are parents of ___________________, Class ____________, B.No._________ ,
admitted in Pinegrove School, Distt Solan HP, do hereby agree and declare as
under:-

(a) I hereby give my full consent and approval to the School (i) for my child to
participate in all activities that are undertaken in the ordinary course of the
functioning of the School for the overall growth, development and
exposure of the child, including particularly in the sports and educational
activities organized by the School for the students including but not limited
to games, yoga, excursions/field trips/ adventures/ outings/ training /
transportation / tours and treks / swimming / mountaineering / rock
climbing / hiking / skating / cycling / horse riding / any adventure activities
and (ii) to allow my child to travel via transport arranged by the School in
relation to the Activities such as to playgrounds, club coaching academies,
competitions, field trips, excursions, picnics, school campus, etc. from time
to time.

(b) I also understand that (a) sports and other co-curricular activities are an
integral part of the School for the overall development of the child and are
compulsory till the child is in School; and (b) organizing tours, excursions,
camps, conferences, competitions, tournaments, student exchanges or any
outing is a part of education and are undertaken in the ordinary course of
the functioning of the School, but participation of my child is at his/her
own risk. Sending my child will automatically be taken as consent from my
side to the School.

(c) I understand that these Activities may involve competition and/or may
involve inherent risks and injuries, and I am willing to assume these risks
and hazards incidental to these Activities and accept general liability for
the participation of my child in these Activities including on behalf of my
child. Accordingly, I do hereby waive, release and undertake to not hold
the School and/or its Principal, staff members, including teaching and non-
teaching staff, and other employees, including counsellors, wardens,
medical personnel,helpers and other representatives liable or responsible
in case of sickness or injuries or accidents that may be suffered by my
child in the course of participation in such Activities or travel as aforesaid.
This also applies to all accidents or injuries which may occur in the science
laboratories, workshops, sports fields, gymnasium, swimming, educational
tours, exchanges, sports representations, conferences, competitions and
journeys to and from the School.

(d) I hereby also certify that my child is fully capable of participating in the
activities and that my child is healthy and has no physical or mental
disabilities or infirmities that would restrict full participation in these
activities.

(e) I also agree to indemnify and hold harmless the School and its
Representatives from any and all risks, proceedings, claims, demands,
costs, charges, expenses, losses and damages (including without limitation
loss due to theft or damage to property), resulting from or arising out of
my child’s negligence, misbehaviour, default or breach or disregard of rules
and regulations or participation in the Activities. I shall be solely and
personally responsible to make good such damage or loss to such person
or property and I shall indemnify the School against all such claims. I also
understand that no financial compensation can be claimed from the School
management and/or the Representatives in this regard.

(f) I also confirm that the child will abide by and follow all standards, policies
and terms of use of the School. I also understand and agree, that if my
child misbehaves or behaves in a disorderly manner or refuses to follow
the instructions of the staff at the School, then the School shall have the
right to undertake appropriate actions to discipline my child and if required
suspend my child’s access to such Activities and the coaching/training
services provided by the School or third parties engaged by the School.

(g) I also confirm and undertake that except for normal wear and tear, in the
event of any breakage/damage to the facilities/equipment of the School
attributable to misuse by my child, the School shall have the right to
recover the costs of the same from me, in my capacity as the
parent/guardian of my child, and I agree to indemnify the School
accordingly.
(h) We/I hereby authorize the school to administer medicines/supplements to
my child under National/State Govt Health Schemes.

Authorization:

I authorize the school authorities to refer my child for any general health
checkup / diagnostic evaluation test as and when required. Further, inthe
event I am unable to be notified by reasonable attempts of the need for any
emergency medical care and treatment for my child, I hereby give our
consent and authorize the school (and their representatives) to assume
consent on our behalf and on behalf of the child to such emergency medical
care and treatment as deemed necessary by any licensed physician; and to
the transfer of my child to any hospital that is reasonably accessible. I fully
understand that School will not be held responsible for any accident or
mishap beyond its reasonable control and agree not to hold the School
responsible or liable for any such emergency care or untoward accidents.

I have read and understood the aforesaid terms entirely and am hereby
executing this form voluntarily and with full knowledge of its
significance.

(1) Signature: ________________________


Father/Guardian Name: ________________________
Date: ________________________

(2) Signature: ________________________


Mother/Guardian Name: ________________________
Date: ________________________

Potrebbero piacerti anche