I_________________________, father/mother of __________________________of
class___________________ willing/not willing to send my ward to the Vidyalaya to continue the classes in
offline mode.
Reason(if many)__________________________________
Date: Signature:
Place: Name:
Contact number:
DECLARATION FORM
NAME OF THE PARENT:___________________________ DATE:_____________
NAME OF THE STUDENT:__________________________ CLASS:_____________
I hereby declare that my ward is()/is not(×) having the following symptoms:
Cough : ________ Fever:__________
Cold/ Runny Nose:________ Breathing Problem :___________ Headache:_________
He/ she is medically fit and can attend the classes regularly.
Suggestions(if any): _________________________________________________________
Parents Sign
Address:_____________________________
Contact No.:__________________________
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