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Student and Parent Consent Form: Saswati Mukherjee (Mother) Joy Mukherjee (Father)

This consent form is for a student named Shrijit Mukherjee to attend medical courses at Aakash Institute Central Kolkata. It acknowledges the risks of COVID-19 from attending in-person classes and allows the school to take safety measures. The parents agree to notify the school if the student travels or is diagnosed with COVID-19. They understand classes may need to be attended online if the student has a fever or is exposed to COVID-19. Both parents provide consent for their child to attend hybrid classes with safety protocols in place.

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Shrijit Mukherjee
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47 views

Student and Parent Consent Form: Saswati Mukherjee (Mother) Joy Mukherjee (Father)

This consent form is for a student named Shrijit Mukherjee to attend medical courses at Aakash Institute Central Kolkata. It acknowledges the risks of COVID-19 from attending in-person classes and allows the school to take safety measures. The parents agree to notify the school if the student travels or is diagnosed with COVID-19. They understand classes may need to be attended online if the student has a fever or is exposed to COVID-19. Both parents provide consent for their child to attend hybrid classes with safety protocols in place.

Uploaded by

Shrijit Mukherjee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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To be completed by Parents

and Students Student and Parent Consent Form

Name of Student:_SHRIJIT MUKHERJEE_


Course: MEDICAL _
PSID No: 00003659152
Name of Centre: _AAKASH INSTITUTE CENTRAL KOLKATA_

The undersigned(s) are the Student and the parent(s), guardian(s), or person(s) in charge of the above-named Student and are collectively referred to
as "Parent”.

The Parent and Student hereby:

(1) Understand that Aakash Institutes throughout West Bengal shall resume physical classes on and from 2nd week of September, 2021, in terms of the
Notification dated 28th August, 2021, issued by The Government of West Bengal.

(2) Understand and agree that it’s optional for the students to attend classes either in the offline or online mode.

(3) Understand and agree that by this Consent Form the Aakash Institute, West Bengal centres- run and managed by Balajee Education Private
Limited, having it’s registered office at 4th Floor, 23 Circus Avenue, Kolkata 700017 (hereinafter referred to as “the Institute”),
(a) has provided to the Parent and Student the option of taking the classes in the online/offline or hybrid mode.
(b) duly informed the parent and student of the existence of potential dangers associated with offline/hybrid mode, which may involve the
risk of contracting contagious diseases such as the COVID-19 virus and or it’s variants/mutants, and such infections may be severe;
and,
(c) even after the use of the best protective equipment and strict observance of rules, covid protocols as prescribed by the Central and/or State
Governments, contracting the Covid-19 virus will still be a possibility;

(4) Consent and agree to the participation of the Student in offline/physical/hybrid (strike out whichever is not applicable) classes, subject to all
Covid-19 protocols; and,

(5) Consent and agree to


(a) the disclosure by the Institute to the appropriate Health Department and or any other described so prescribed by the Central and/or State
Government, of information regarding the Student, including the student’s name, address, telephone listing, electronic mail address, dates
of attendance, in the event detection of any signs and symptoms of Covid-19,
(b) notify the institute in writing about;
i) information about inter-state and international travel by the student, parents and any other person residing along with such
student.
ii) information about any student, parents and any other person residing along with such student- having been diagnosed with
Covid-19.

(6) Consent, agree and authorize the Institute to check temperature with digital thermometers and send back any student running a temperature
beyond 98.4 degrees Fahrenheit.In such event or in case of any warning prompted by the Arogya Setu app, my ward shall attend the online
classes and we shall not claim any compensation for not attending classes at the Institute

I/We acknowledge that I/We have read paragraphs (1) through (6) above, understand and agree to the terms thereof, including the warning of potential
risk of contracting Covid 19 while attending classes in offline and/or hybrid mode.

SHRIJIT MUKHERJEE 18.09.2021

Name of Student Student's Signature Date

(I am)(We are) the Student’s (Parents) /(Guardian). (I)(We) acknowledge that (I)(We) have read paragraphs (1) through (6) above, understand and
agree to the terms thereof, including the warning of potential risk of contracting Covid-19 while attending classes in offline and/or hybrid mode.
Having read the warning in paragraph (3) above and understanding the potential risk of contracting Covid-19 while attending classes in offline and/or
hybrid mode, (I)(we) hereby give (my)(our) permission for _ [student name] to attend classes in the offline and/or hybrid mode, at ;

Central Kolkata North Kolkata South Kolkata Bansdroni Barrackpore Durgapur Siliguri Kharagpur The Newtown School

All information provided above are true and correct to the best of my knowledge and belief and nothing material has been concealed therefrom.

Parent(s)/Guardian Printed Name(s)* Parent/Guardian Signature Date of Signature


Saswati Mukherjee(Mother) 18.09.2021

Joy Mukherjee(Father) 18.09.2021

*Both Mother and Father must sign, unless parents are divorced/separated, the custodial parent must sign, or if the student is not living with
parents,the student’s legal guardian.

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