THSR/2019-20/Admin/034

22nd August, 2019

Swiss Innovation Camp

Session-2019-20

Dear Parent
Greetings from The Heritage Family!
We are excited to have your child to attend the Swiss Innovation camp 2019-20 from 13th October, 2019
to 20st October, 2019. Hope you are all well and equally excited for the same. As per our discussion
during the orientation held on 20th July, 2019 regarding the trip, we are enclosing the details of the
programme once again for your kind reference.
No. of Days : 7-Nights and 8-Days
Venue : Geneva
Stay/Accommodation: Hotel -Holiday Inn Express
Activities : Workshops, Learning walks and Site visits
Collaborating Agency : Life Lab Organization
Trip Dates : 13th October, 2019 to 20th October, 2019
Campus/Venue : CERN Geneva
Travel : DEPARTURE: DELHI, DL (INDIRA GANDHI INTL), TERMINAL 3
13th October 11:00 am
FLIGHT EK 511 - EMIRATES
(Details of the travel will be furnished later)
Stay : Hotel -Holiday Inn Express on sharing basis
Programme Fee : Rs. 1,91,0000/-

We are in the process of applying for the Visa for the same, you are requested to mandatorily submit
the following documents to school for Visa process and as part of School policy for outbound trips, for
the safety and security of your child.

Things to be kept in mind while submitting documents:

1. Kindly go through the 'CHECKLIST & GUIDELINES' documents thoroughly while filling in ANNEX 1-6,
for Visa as well as preparing other documents mentioned in the checklist.
2. Take out separate printout outs for each category of document not back to back

3. Submit hard copies of these documents with necessary details filled and signatures (wherever
applicable), in 2 separate clear bags – One for the school documents and another for Visa
documents, with the name and class of the child mentioned on labels clearly.

4. For any query regarding the same, you can mail for further clarification to
ritu.bhatt@rohini.theheritageschool.in or contact on 9990232035

5. Documents (in hard copy) need to be deposited to Ms Ritu Bhatt latest by 26th August 2019 for
the first review.

List of School Documents Attached for Reference and Consent :

 Itinerary of the Programme (For reference only- Do not submit this)

 Informed Consent (For reference only- Do not submit this)
 Clear Bag-1 : Documents to be submitted to school as part of school policy for outbound trips:
1. Parent Consent Form
2. Medical Terms & Conditions
3. Parent Consent for Medical Terms & Conditions
4. Medical Form (To be submitted to school if applicable to give us clarity about any health issue or
medication that your child is undergoing)
(Please note: All Formats for abovesaid are attached along with the circular)

List of Visa Documents Attached for Reference and Submission:

Checklist and Guidelines (For reference only- Not to be submitted)

i. For all subsequent documents, Please refer to the attachments

ii. All covering letters and formats need to be edited/typed before printing
iii. Please do not fill the annexures by hand unless mentioned in the description

Clear Bag-2: Documents for applying for Schengen Visa.

1. Current and previous passport/s of the Applicant
2. Clear photocopy of the passport
3. Two recent photographs
Check link below for a detailed guide on photograph specifications:
http://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-Photograph_Guidelines.pdf
4. Identity proof of parents - A photocopy of Passport or Pan Card of BOTH PARENTS must be submitted
5. Photocopy of the official student ID from School i.e I -Card
6. Salary Slips/ Proof of Business- Last three months of salary slips for BOTH parents, in case of salaried parents
Proof of business ownership in case of private business
7. Income Tax Return (ITR V or F16): ITR V form only of last two consecutive years for BOTH parents
8. Visa application form (Form C) Annexure 1 A -Attached
9. Parents Covering Letter -Format Attached-Annexure 2
10. Consent letter with Notary Stamp- Annexure-3 Attached
11. Authorisation Letter – Annexure -4 attached
12. Notarised affidavit- ANNEX 5 – Attached -. To be printed on a 100 Rupee stamp paper signed and stamped
by a public notary
13. PARENT UNDERTAKING ANNEX 6 – Attached .This document can be filled by hand To be filled and signed by
both parents
14. Official bank statement of BOTH parents’ saving accounts -To be signed and stamped by the bank manager
on each page. It should be for the last 3 months from the date of issue (On A 4 Sheet) – (This to be collected
one week before final VISA submission date which will be informed hence not required in this folder right
now.)

Once we get detailed feedback on the files we will update you for any further document needed and ask you to
submit bank statement.

Please note adhering to the dates helps us make other logistics arrangements well ahead of the programme. The
cost of travel may change subject to the mode of transportation and the time of booking.

Regards
Co-curricular Incharge
 22nd August, 2019

Swiss Innovation Camp

(Grades VIII-X)

Itinerary
From 13th Oct, 2019 to 20th October, 2019

Please note the itinerary is subject to change depending on group dynamics, weather conditions or any other
unforeseen situation.

Regards
Co-curricular Incharge
 22nd August, 2019

Swiss Innovation Camp

(Grades VIII-X)

INFORMED CONSENT
Dear Parents,

The Outbound Programme is an integral part of our curriculum addressing the big idea -
‘Preparing the child for life through life’.

During Out Bound International Trips your child will be participating in various activities that are more demanding
than those encountered in everyday life. As shared with you during our orientation, safety and security is of
paramount importance to us. Keeping in mind the safety and well-being of the children, we have designed protocols,
processes, and systems which were shared in detail during the parents’ orientation. School frequently discusses and
reviews these safety measures from time to time, before, while and post the expeditions and also with the students
during the expedition. The need to respect and adhere to instructions and guidelines is of utmost importance and
we would like you to discuss this with your child.

We will travel by bus/train/ flight and will stay in dormitories/rooms in established facilities as per the details
provided. Program is facilitated by experienced professionals who oversee all arrangements and the learning
activities in the program. Your child’s teachers, who are a part of the team, will be there to provide care or any
support that your child may be in need of. There will be experienced facilitators from the organizing vendor with the
details of dates, timings and other relevant information about the program.

It is impossible to know or list every risk associated with all activities. Some, but not all, risks the child may encounter
are mishap due to natural calamities, road accidents, medical emergencies beyond our organized medical support at
the site, etc.

In addition to any physical condition, any information such as anxiety, depression, extra sensitivity or any social-
emotional problems or difficulties that your child might be going through must be informed to the Event
Coordinator. All information shall be maintained confidential by the school and the facilitator and all reasonable
efforts, where possible, will be made to address these issues. Please be aware that the children are not
accompanied by any counsellor to address any situation or issue where your child’s condition may pose a threat to
the physical or emotional safety of himself / herself, or to others. In such cases, the school and the event facilitators
may at its sole discretion refuse to permit participation or may require the parent/guardian to escort the child back.

We would request you to carefully read the information provided, assess the suitability of the proposed
trip/event/policy to your child’s individual needs or condition; satisfy yourself on the arrangements made and
acknowledge the inherent risks that may be applicable.

If you would like your child to participate in this trip, please complete the attached Consent Form. If we do not
receive the Consent Form and the program fee latest by the prescribed date we will assume that your child will not
be participating.

We look forward to an exciting journey of learning!

Regards
Co-curricular Incharge
 22nd August, 2019

Swiss Innovation Camp

(Grades VIII-X)

Parent Consent
[To be filled by parents]

(To be returned no later than 26th August, 2019. Please note, your child/ward will be permitted to participate in
the proposed out-station field trip only if this Consent Form is signed and received on or before the above-
mentioned date.)

I have read through Circular dated 22nd August, 2019 for the International Swiss Innovation Camp
programme organized by school in collaboration with Life Lab Organization scheduled from 13th October, 2019 to
20th October, 2019. I voluntarily consent to my child going on and actively participating in this field trip.

I am aware of this this program, its objectives and the overall activities that my child might be participating in. I have
read the trip itinerary mentioned in the concerned Circular and noted the transportation and accommodation
arrangements and accompanying teachers. I also understand and acknowledge that there are inherent risks
associated with outdoor programs and related logistics of travel and stay, which despite the due care taken in
planning and executing this activity may not be mitigated. Therefore, I understand and agree that in the event of any
accident or illness, I authorise The Heritage School staff and the adult member of the delegation accompanying my
child to take such steps as necessary for the proper treatment and care of my child.

I have ensured that my child understands that it is important for his/ her safety and the safety of the group that he/
she obeys any rules and instructions given by the staff in charge.

Should my child break the code of conduct mentioned in the Circular related to the trip, I agree to support the
school’s implementation of appropriate disciplinary action which may include returning the ward home at my
expense.

I also understand that the school reserves the right to refuse participation on the proposed program based on an
assessment of the health information. I will acknowledge the school’s rights in this regard and will accept any such
decision.

I have also read the Medical Terms and Conditions and those are acceptable to me.

By my signature, I voluntarily confirm my satisfaction with the itinerary arrangements and field trip details shared
with me through the concerned Circular and therefore, attach the aadhaar card copy of my child.

Parent/Guardian name: Signature

Relationship to Student: Telephone #:

Student name : Emergency Contact:

Date: Grade:

Regards
Co-curricular Incharge
 22nd August, 2019

Swiss Innovation Camp

(Grades VIII-X)

Medical Terms & Conditions and Consent Form

(To be filled by Parent/Guardian)

Please read carefully and sign. Your signature indicates that you fully understand and agree to the authorizations and
acknowledgements of your responsibilities and waiver of liabilities.

TERMS & CONDITIONS

As discussed in the parents’ orientation Health and well being of our children is of utmost priority to us. The school has
processes and protocols in place, to ensure medical safety of our children. The Medical and Health record of the child provided
annualy by the parent, the Medical Form attached and the subsequent Medical Parent Consent Form is an attempt to take all
preventive measures for avoiding any medical exigency. Yet, there could be situations beyond the school’s control.

The school staff will be responsible to provide care and necessary support in the event that the student becomes ill or
incapacitated during the programme. However, the medical assistance will be provided for the first 48 hours if required, in
accordance with the recommendations of a qualified medical practitioner. The school will contact the parent prior to such
treatment and care unless there is an emergency wherein life saving measures have to be taken. It is the parent’s responsibility
to oversee the treatment of the student after the initial 48 hours of the injury/illness. The student will be allowed to re-join the
programme only after receiving a clearance from a qualified medical practitioner.

Wherever applicable, if the student becomes ill or comes into contact with any contagious or infectious disease during the 21
days prior to the commencement of the programme, the parent must immediately notify the school staff in writing and provide
a Medical Certificate from the student’s doctor giving approval for the student to participate in the programme. It is your and
the student’s responsibility to help prevent the spread of infectious diseases.

It is the parent’s responsibility to inform the school staff prior to the commencement of the programme of any issue or
condition that may affect student’s stay at/participation in the programme. These include but are not limited to any disabilities,
medical conditions, dietary restrictions, allergies, behavioural/social issues, child’s history. The information regarding any
medical need must be provided in the attached Medical Form.

We would request you to read the Medical History Form available in your ERP login as it will be referred to at the time of
emergency.
PARENT’S CONSENT

1) I have read the Medical History Form of my ward and confirm that there is no change in the same.
2) I grant my authorization and consent to the school staff to seek emergency diagnostic/medical treatment or care as
required by my child. I understand the school staff will contact me prior to such treatment or care. In case of
unforeseen circumstances, I understand the school staff will notify me as soon as possible, of any diagnosis or
treatment provided. In case of our unavailability to take the call, the teachers/the authorized instructor will proceed to
take the decision most suitable in the interest of the safety of the child.
3) In situations such as fever, body ache, headache or other minor ailments school can administer Tablet/syrup crocin to
the child without waiting for my consent.
4) I agree that the school is not responsible or liable for any treatment provided.
5) I accept full responsibility for payment of any and every invoice or bill for treatment of care provided to my child.
6) I hereby release the school staff from all expenses or liabilities resultant of :
- Any emergency medical treatment or care provided to my child.
- My child failing to adhere to her/his medication schedule.

Details of the doctors who can be contacted in case of any emergency or for reference are as follows:

Doctor 1: Name : ____________________________Contact No. : ________________________

Doctor 2: Name : ____________________________ Contact No. :________________________

Signature of Parent / Guardian___________________________ Date ___________________

Name of Parent/Guardian________________________________________________________
Relationship to Applicant________________________________________________________
 22nd August,2019

Swiss Innovation Camp

(Grades VIII-X)

Medical Form for School Expeditions/Trips/Tours/Competition/Tournament

(to be filled in case your child is under medication/undergoing any treatment during the period of the programme)

IMPORTANT : The parent must refer to and ensure that the details provided in the Medical Form ( available in
your ERP login )are updated as on date before filling up this form.

PRESCRIPTION MEDICATIONS (must be filled by Medical Practitioner)

(In case your child is undergoing any treatment during the period of the programme)

 Medical Practitioner must list all medications prescribed to the participant, including dosage and schedule.
 Participant must carry original medicine bottles labelled with their name, contents and dosage information.
In case of pre-packed pill organizers, participant must carry corresponding pill bottles dispensed by
pharmacy labelled with name, contents and dosage information.

Medication: __________________ Dosage: ______ Time : ______ a.m. _____ p.m.

Medication: __________________ Dosage: ______ Time : ______ a.m. _____ p.m.
Medication: __________________ Dosage: ______ Time : ______ a.m. _____ p.m.

Participant will take medication from (dates) ____________ to ____________

Important information (side effects, toxic reactions, drug interactions, omission reactions, potential problems
resulting from physical injury): _____________________________________________________
_______________________________________________________________________________________

Contraindications for medication administration: _______________________________________________

Parents must ensure that all medication that their child is carrying has been labeled by the pharmacist with the
following information:

 Child’s Name
 Dosage prescribed
 Medication dispensed
 Time at which medication must be taken

Medical Practitioner’s Signature: _______________________ Date : ____________

IMPORTANT :

1 The school will not prescribe, dispense or administer any medication. Students under medication need to
be able to administer the medication on their own.
2 Parents/Guardians must ensure that their child is aware of his/her own medication schedule.
3 The School will not oversee participant’s adherence to the medication schedule.

Regards
Co-curricular Incharge
 1. CURRENT AND PREVIOUS PASSPORTS OF THE APPLICANT

a. Must not be older than 10 years from the date of issue

b. Must be valid for at least 3 months from the date of scheduled return
c. Must have at least two blank pages to affix the visa stamp
d. All previous passports must be attached with the original

2. CLEAR PHOTOCOPY OF THE PASSPORT

a. Photocopy of the front and the last page of the passport

o Please check the expiry date on the passport

o Expiry should be at least 3 months from the scheduled date of return
o No pages should be missing from the passport

3. TWO RECENT PHOTOGRAPHS

a. Two identical photos the size of 35-40 mm width

b. The face should cover 80% of the photo area with white background
c. Teeth should not be visible in the photographs

Check link below for a detailed guide on photograph specifications:

http://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-
Photograph_Guidelines.pdf

Copyright©2019 Life Lab Foundation

 4. IDENTITY PROOF OF PARENTS (NOT APPLICABLE FOR TEACHERS)

a. A photocopy of Passport or Pan Card of BOTH PARENTS must be submitted

b. Signature on all other forms and letters should match the signature on ID provided

5. PHOTOCOPY OF THE STUDENT ID

a. Photocopy of the official student ID from School

6. SALARY SLIPS / PROOF OF BUSINESS

a. Last three months of salary slips for BOTH parents, in case of salaried parents
b. Proof of business ownership in case of private business
i. Bank statement or GST certificate for Sole Proprietorship
ii. Partnership deep for Partnership firms
iii. MOU/AOU for Private Limited Firms

7. PERSONAL BANK STATEMENT

a. Official bank statement of BOTH parents’ saving accounts

b. Statement to be signed and stamped by the bank manager on each page
c. Statement should be for the last 3 months from the date of issue
d. Average balance should be at least 2-3 Lacs total in both parents’ account
e. All bank statements should be on A4 sheet
f. To be collected one week before final VISA submission date

8. INCOME TAX RETURN (ITR V or F16)

a. ITR V form only of last two consecutive years for BOTH parents
b. If the latest ITRV is unavailable, submit the ITR V of the 2 preceding years
c. FORM 16 for last two consecutive years, for parents who draw a salary
d. J FORM and Exemption certificate for parents who are exempt from paying tax

Continued…

Copyright©2019 Life Lab Foundation

 Sample of Form 16

Continued…

Copyright©2019 Life Lab Foundation

 Sample of ITR V

Continued…

Copyright©2019 Life Lab Foundation

NOTE:

i. For all subsequent documents, Please refer to the attachments sent with this list
ii. All covering letters and formats need to be edited/typed before printing
iii. Please do not fill the annexures by hand unless mentioned in the description

9. VISA APPLICATION FORM (FORM C) ANNEX 1A – Attached

a. Please read the form filling instructions (Annex 1B) before filling the form
b. Some entries have already been filled, please do not delete that information
c. Please type all entries on the PDF before the printing the form
d. Please make sure that both parents sign the form after printing it (in both boxes)

Both parents should sign in both these boxes.

Please remember that BOTH parents should sign on top and bottom of the page.

Copyright©2019 Life Lab Foundation

 10. PARENTS COVERING LETTER ANNEX 2 – Attached

a. A covering letter, prepared and signed by both parents

b. Covering letter draft attached for your reference
c. Please fill in the entries before taking the print and signing the letter

11. CONSENT LETTER WITH NOTARY STAMP ANNEX 3 – Attached

a. Can be printed on a regular A4 sheet

b. To be signed and stamped by a public notary
c. The letter has to be signed by both the parents
d. Covering letter draft attached for your reference
e. Please fill in the entries before taking the print and signing the letter

12. AUTHORIZATION FORM ANNEX 4 – Attached

a. Please fill the students’ name in the top bar

b. Leave the company name blank and representative name blank
c. Please attach a passport copy of the student and both the parents with this form

Write student name

Leave blank
Leave blank

Parents’ numbers

Student and Parents’ signature

Attach student and parents’

passport copy

Copyright©2019 Life Lab Foundation

 13. NOTARISED AFFIDEVIT ANNEX 5 – Attached

a. To be printed on a 100 Rupee stamp paper

b. To be signed and stamped by a public notary
c. The letter has to be signed by both the parents
d. Please mention the accompanying school teacher as travel guardian
e. The witness can be anyone present during signing of the document

14. PARENT UNDERTAKING ANNEX 6 – Attached

a. This document can be filled by hand

b. To be filled and signed by both parents

- END -

Copyright©2019 Life Lab Foundation

 PASTE PHOTO

PERSONAL
DETAILS

DETAILS OF PARENTS IF
STUDENT IS BELOW 18

PASSPORT NUMBER AND DETAILS

 HOME ADDRESS IF STUDENT IS A DAY BOARDER

 SCHOOL ADDRESS IF LIVING IN SCHOOL CAMPUS/HOSTELS
SCHOOL ADDRESS AND
CONTACT DETAILS

LEAVE AS IT IS

SCHENGEN VISA TRAVEL

HISTORY
 DATE OF ENTRY AND
EXIT FROM GENEVA

LEAVE AS IT IS

WRITE NA

SPONSORED/SCHOLARSHIP CANDIDATES TO
SELECT THE SECOND OPTION
PLACE AND DATE OF SIGNATURE

SIGNATURE OF BOTH PARENTS

PLACE AND DATE OF SIGNATURE

SIGNATURE OF BOTH PARENTS

 PHOTO

Application for Schengen Visa

Antrag auf Erteilung eines Schengen-Visums
This application form is free
Dieses Antragsformular ist unentgeltlich

1. Surname (Family name) / Name (Familienname) (x) RESERVIERT FÜR AMTLICHE

EINTRAGUNGEN

2. Surname at birth [Earlier family name(s)] / Familienname bei der Geburt [frühere(r) Familienname(n)] (x) Datum des Antrags:

3. First name(s) [Given name(s)] / Vorname(n) (x) Nummer des

Visumantrags:

4. Date of birth (day-month-year) / 5. Place of birth / Geburtsort 7. Current nationality / Derzeitige

Geburtsdatum (Tag-Monat-Jahr) Staatsangehörigkeit Antrag eingereicht bei:
□ Botschaft/Konsulat
□ Gemeinsame Antrags-
bearbeitungsstelle
6. Country of birth / Geburtsland Nationality at birth, if different / □ Dienstleistungserbringer
Staatsangehörigkeit bei der Geburt □ Kommerzieller
(falls abweichend) Vermittler
□ Grenze
Name:
8. Sex / Geschlecht 9. Marital status / Zivilstand □ Andere

□ Male / Männlich □ Single / Ledig

□ Married / Verheiratet Akte bearbeitet durch:
□ Female / Weiblich □ Separated / Getrennt
□ Divorced / Geschieden
□ Widow(er) / Verwitwet Belege:
□ Other (please specify) / Sonstiges (bitte nähere Angaben) □ Reisedokument
□ Mittel zur Bestreitung
des Lebensunterhalts
10. In the case of minors: Surname, first name, address (if different from applicant´s) and nationality of parental □ Einladung
authority/legal guardian / Bei Minderjährigen: Name, Vorname, Anschrift (falls abweichend von der des □ Transportmittel
Antragstellers) und Staatsangehörigkeit des Inhabers der elterlichen Sorge/des Vormunds □ Reisekranken-
versicherung
□ Sonstiges:

11. National identity number, where applicable / ggf. nationale Identitätsnummer Visum:
□ Abgelehnt
□ Erteilt
12. Type of travel document / Art des Reisedokuments □A
□C
□ Ordinary passport / Normaler Pass □ Official passport / Amtlicher Pass □ VrG
□ Diplomatic passport / Diplomatenpass □ Special passport / Sonderpass
□ Service passport / Dienstpass
□ Other travel document (please specify) / Sonstiges Reisedokument (bitte nähere Angaben) Gültig:
von

13. Number of travel document / 14. Date of issue / 15. Valid until / 16. Issued by / Ausgestellt durch bis
Nummer des Reisedokuments Ausstellungsdatum Gültig bis
Anzahl Einreisen:
□ 1 □ 2 □ Mehrfach
17. Applicant’s home address and e-mail address / Wohnanschrift und E- Telephone number(s) /
Mail-Anschrift des Antragstellers Telefonnummer(n)
Anzahl der Tage:

(x) Fields 1-3 shall be filled in accordance with the data in the travel document.
(x) Die Felder 1-3 sind entsprechend den Angaben im Reisedokument auszufüllen.
18. Residence in a country other than the country of current nationality / Wohnsitz in einem anderen Staat als
dem, dessen Staatsangehörige(r) Sie gegenwärtig sind

□ No / Nein
□ Yes. Residence permit or equivalent No. Valid until
Ja. Aufenthaltstitel oder gleichwertiges Dokument Nr. Gültig bis

*19. Current occupation / Derzeitige berufliche Tätigkeit

*20. Employer and employer’s address and telephone number. For students, name and address of educational
establishment / Anschrift und Telefonnummer des Arbeitgebers. Für Studenten, Name und Anschrift der
Bildungseinrichtung

21. Main purpose(s) of the journey / Hauptzweck(e) der Reise

□ Visit of family or friends / Besuch von Familienangehörigen oder Freunden

□ Tourism / Tourismus
□ Business / Geschäftsreise
□ Cultural / Kultur
□ Transit / Durchreise
□ Official visit / Offizieller Besuch
□ Study / Studium
□ Medical reasons / Gesundheitliche Gründe
□ Sports / Sport
□ Airport transit / Flughafentransit
□ Other (please specify) / Sonstiges (bitte nähere Angaben)

22. Member State(s) of destination / 23. Member State of first entry / Mitgliedstaat der
Bestimmungsmitgliedstaat(en) ersten Einreise

24. Number of entries requested / Anzahl der beantragten 25. Duration of the intended stay or transit / Dauer
Einreisen des geplanten Aufenthalts oder der Durchreise

□ Single entry / Einmalige Einreise Indicate number of days / Anzahl der Tage
□ Two entries / Zweimalige Einreise angeben
□ Multiple entries / Mehrfache Einreise

26. Schengen visas issued during the past three years / Schengen-Visa, die in den vergangenen drei Jahren erteilt
wurden

□ No / Nein
□ Yes. Date(s) of validity from to
Ja. Gültig von bis

27. Fingerprints collected previously for the purpose of applying for a Schengen visa / Wurden Ihre
Fingerabdrücke bereits für die Zwecke eines Antrags auf ein Schengen-Visum erfasst?

□ No / Nein □ Yes. Date (if known) / Ja, Datum (falls bekannt)

28. Entry permit for the final country of destination, where applicable / Gegebenenfalls Einreisegenehmigung für
das Endbestimmungsland

Issued by Valid from until

Ausgestellt durch Gültig von bis

The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while exercising their right to free
movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields no 34 and 35.

Die mit * gekennzeichneten Felder müssen von Familienangehörigen von Unionsbürgern und von Staatsangehörigen des EWR oder der Schweiz (Ehegatte, Kind oder
abhängiger Verwandter in aufsteigender Linie) in Ausübung ihres Rechts auf Freizügigkeit nicht ausgefüllt werden. Diese müssen allerdings ihre
Verwandtschaftsbeziehung anhand von Dokumenten nachweisen und die Felder Nr. 34 und 35 ausfüllen.
29. Intended date of arrival in the Schengen area / 30. Intended date of departure from the Schengen area /
Geplantes Ankunftsdatum im Schengen-Raum Geplantes Abreisedatum aus dem Schengen-Raum

*31. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of hotel(s)
or temporary accommodation(s) in the Member State(s) / Name und Vorname der einladenden Person(en) in
dem Mitgliedstaat bzw. den Mitgliedstaaten. Soweit dies nicht zutrifft, bitte Name des/der Hotels oder
vorübergehende Unterkunft (Unterkünfte) in dem (den) betreffenden Mitgliedstaat(en) angeben

Address and e-mail address of inviting person(s)/hotel(s)/temporary Telephone and telefax / Telefon und Fax
accommodation(s) / Adresse und E-Mail-Anschrift der einladenden
Person(en)/jedes Hotels/jeder vorübergehenden Unterkunft

*32. Name and address of inviting company/organisation / Name und Telephone and telefax of
Adresse des einladenden Unternehmens/der einladenden company/organisation / Telefon und Fax
Organisation des Unternehmens/der Organisation

Surname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation /
Name, Vorname, Adresse, Telefon, Fax und E-Mail-Anschrift der Kontaktperson im Unternehmen/in der
Organisation

*33. Cost of travelling and living during the applicant's stay is covered / Die Reisekosten und die
Lebenshaltungskosten während des Aufenthalts des Antragstellers werden getragen
□ by the applicant himself/herself / vom □ by a sponsor (host, company, organisation) / von
Antragsteller selbst anderer Seite (Gastgeber, Unternehmen,
Organisation)
Means of support / Mittel zur Bestreitung des □ referred to in field 31 or 32 / siehe Feld 31 oder
Lebensunterhalts 32
□ Cash / Bargeld □ other (please specify) / von sonstiger Stelle
□ Credit Card / Kreditkarte (bitte nähere Angaben)
□ Traveller's cheques / Reiseschecks
□ Prepaid accommodation / Im Voraus bezahlte
Unterkunft Means of support / Mittel zur Bestreitung des
□ Prepaid transport / Im Voraus bezahlte Lebensunterhalts
Beförderung □ Cash / Bargeld
□ Other (please specify) / Sonstiges (bitte nähere □ Accommodation provided / Zur Verfügung
Angaben) gestellte Unterkunft
□ All expenses covered during the stay / Übernahme
sämtlicher Kosten während des Aufenthalts
□ Prepaid transport / Im Voraus bezahlte
Beförderung
□ Other (please specify) / Sonstiges (bitte nähere
Angaben)

34. Personal data of the family member who is a EU, EEA or CH citizen / Persönliche Daten des
Familienangehörigen, der Unionsbürger oder Staatsangehöriger des EWR oder der Schweiz ist
Surname / Name First name(s) / Vorname(n)

Date of birth / Geburtsdatum Nationality / Nationalität Number of travel document or ID

card / Nr. des Reisedokuments oder
des Personalausweises

The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while exercising their right to free
movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields no 34 and 35.

Die mit * gekennzeichneten Felder müssen von Familienangehörigen von Unionsbürgern und von Staatsangehörigen des EWR oder der Schweiz (Ehegatte, Kind oder
abhängiger Verwandter in aufsteigender Linie) in Ausübung ihres Rechts auf Freizügigkeit nicht ausgefüllt werden. Diese müssen allerdings ihre
Verwandtschaftsbeziehung anhand von Dokumenten nachweisen und die Felder Nr. 34 und 35 ausfüllen.
35. Family relationship with an EU, EEA or CH citizen / Verwandtschaftsverhältnis zum Unionsbürger oder
Staatsangehörigen des EWR oder der Schweiz

□ Spouse / Ehegatte □ Child / Kind □ Grandchild / Enkelkind

□ Dependent ascendant / Abhängiger Verwandter in aufsteigender Linie

36. Place and date / Ort und Datum 37. Signature (for minors, signature of parental authority/legal
guardian) / Unterschrift (für Minderjährige Unterschrift des
Inhabers der elterlichen Sorge/des Vormunds)

I am aware that the visa fee is not refunded if the visa is refused.
Mir ist bekannt, dass die Visumgebühr im Falle der Visumverweigerung nicht erstattet wird.

Applicable in case a multiple-entry visa is applied for (cf. field no 24): I am aware of the need to have an adequate travel medical insurance
for my first stay and any subsequent visits to the territory of Member States.
Im Falle der Beantragung eines Visums für mehrfache Einreisen (siehe Feld 24): Mir ist bekannt, dass ich über eine angemessene
Reisekrankenversicherung für meinen ersten Aufenthalt und jeden weiteren Besuch im Hoheitsgebiet der Mitgliedstaaten verfügen muss.

I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph and, if applicable, the taking of
fingerprints, are mandatory for the examination of the visa application. Any personal data concerning me which appear on the visa application form, as well as my
fingerprints and my photograph will be supplied to the relevant authorities of the Member States and processed by those authorities, for the purposes of a decision on my
visa application.
Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend a visa issued will be entered into, and stored in
the Visa Information System (VIS) 1 for a maximum period of five years, during which it will be accessible to the visa authorities and the authorities competent for carrying
out checks on visas at external borders and within the Member States, immigration and asylum authorities in the Member States for the purposes of verifying whether the
conditions for the legal entry into, stay and residence on the territory of the Member States are fulfilled, of identifying persons who do not or who no longer fulfil these
conditions, of examining an asylum application and of determining responsibility for such examination. Under certain conditions the data will be also available to
designated authorities of the Member States and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal
offences. The authority of the Member State responsible for processing the data is the State Secretariat for Migration SEM.
I am aware that I have the right to obtain in any of the Member States notification of the data relating to me recorded in the VIS and of the Member State which transmitted
the data, and to request that data relating to me which are inaccurate be corrected and that data relating to me processed unlawfully be deleted. At my express request, the
authority examining my application will inform me of the manner in which I may exercise my right to check the personal data concerning me and have them corrected or
deleted, including the related remedies according to the national law of the State concerned. The national supervisory authority of that Member State (Federal Data
Protection and Information Commissioner PDPIC, Feldeggweg 1, 3003 Bern) will hear claims concerning the protection of personal data.
I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being
rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law of the Member State which deals with the application.
I undertake to leave the territory of the Member States before the expiry of the visa, if granted. I have been informed that possession of a visa is only one of the
prerequisites for entry into the European territory of the Member States. The mere fact that a visa has been granted to me does not mean that I will be entitled to
compensation if I fail to comply with the relevant provisions of Article 5(1) of the Schengen Borders Code and am thus refused entry. The prerequisites for entry will be
checked again on entry into the European territory of the Member States.

Mir ist bekannt und ich bin damit einverstanden, dass im Hinblick auf die Prüfung meines Visumantrags die in diesem Antragsformular geforderten Daten erhoben werden
müssen, ein Lichtbild von mir gemacht werden muss und gegebenenfalls meine Fingerabdrücke abgenommen werden müssen. Die Angaben zu meiner Person, die in
diesem Visumantrag enthalten sind, sowie meine Fingerabdrücke und mein Lichtbild werden zwecks Entscheidung über meinen Visumantrag an die zuständigen Behörden
der Mitgliedstaaten weitergeleitet und von diesen Behörden bearbeitet.
Diese Daten sowie Daten in Bezug auf die Entscheidung über meinen Antrag oder eine Entscheidung zur Annullierung, Aufhebung oder Verlängerung eines Visums
werden in das Visa-Informationssystem (VIS)1 eingegeben und dort höchstens fünf Jahre gespeichert; die Visumbehörden und die für die Visumkontrolle an den
Außengrenzen und in den Mitgliedstaaten zuständigen Behörden sowie die Einwanderungs- und Asylbehörden in den Mitgliedstaaten haben während dieser fünf Jahre
Zugang zum VIS, um zu überprüfen, ob die Voraussetzungen für die rechtmäßige Einreise in das Gebiet und den rechtmäßigen Aufenthalt im Gebiet der Mitgliedstaaten
erfüllt sind, um Personen zu identifizieren, die diese Voraussetzungen nicht bzw. nicht mehr erfüllen, um einen Asylantrag zu prüfen und um zu bestimmen, wer für diese
Prüfung zuständig ist. Zur Verhütung und Aufdeckung terroristischer und anderer schwerer Straftaten und zur Ermittlung wegen dieser Straftaten haben unter bestimmten
Bedingungen auch benannte Behörden der Mitgliedstaaten und Europol Zugang zu diesen Daten. Die für die Verarbeitung der Daten zuständige Behörde des Mitgliedstaats
ist das Staatssekretariat für Migration SEM.
Mir ist bekannt, dass ich berechtigt bin, in jedem beliebigen Mitgliedstaat eine Mitteilung darüber einzufordern, welche Daten über mich im VIS gespeichert wurden und
von welchem Mitgliedstaat diese Daten stammen; außerdem bin ich berechtigt, zu beantragen, dass mich betreffende Daten, die unrichtig sind, korrigiert und rechtswidrig
verarbeitete Daten, die mich betreffen, gelöscht werden. Die konsularische Vertretung, die meinen Antrag prüft, liefert mir auf ausdrücklichen Wunsch Informationen
darüber, wie ich mein Recht wahrnehmen kann, die Daten zu meiner Person zu überprüfen und unrichtige Daten gemäß den Rechtsvorschriften des betreffenden
Mitgliedstaats ändern oder löschen zu lassen, sowie über die Rechtsmittel, die das Recht des betreffenden Mitgliedstaats vorsieht. Die staatliche Aufsichtsbehörde dieses
Mitgliedstaats (Eidg. Datenschutz- und Öffentlichkeitsbeauftragter EDÖB, Feldeggweg 1, 3003 Bern) ist zuständig für Beschwerden über den Schutz personenbezogener
Daten.
Ich versichere, dass ich die vorstehenden Angaben nach bestem Wissen und Gewissen gemacht habe und dass sie richtig und vollständig sind. Mir ist bewusst, dass falsche
Erklärungen zur Ablehnung meines Antrags oder zur Annullierung eines bereits erteilten Visums führen und die Strafverfolgung nach den Rechtsvorschriften des
Mitgliedstaats, der den Antrag bearbeitet, auslösen können.
Ich verpflichte mich dazu, das Hoheitsgebiet der Mitgliedstaaten vor Ablauf des Visums zu verlassen, sofern mir dieses erteilt wird. Ich wurde davon in Kenntnis gesetzt,
dass der Besitz eines Visums nur eine der Voraussetzungen für die Einreise in das europäische Hoheitsgebiet der Mitgliedstaaten ist. Aus der Erteilung des Visums folgt
kein Anspruch auf Schadensersatz, wenn ich die Voraussetzungen nach Artikel 5 Absatz 1 der Verordnung (EG) Nr. 563/2006 (Schengener Grenzkodex) nicht erfülle und
mir demzufolge die Einreise verweigert wird. Die Einreisevoraussetzungen werden bei der Einreise in das europäische Hoheitsgebiet der Mitgliedstaaten erneut überprüft.

Place and date / Ort und Datum Signature (for minors, signature of parental authority/legal guardian) /
Unterschrift (für Minderjährige Unterschrift des Inhabers der elterlichen
Sorge/des Vormunds)

1
Insofar as the VIS is operational / Soweit das VIS einsatzfähig ist
To,

The Consular officer,

Embassy of Switzerland in New Delhi
Nyaya Marg, Chanakyapuri
New Delhi – 110021
Tel.: (+91 11) 4995 9500
Fax: (+91 11) 4995 9509

Respected Sir/Madam,

We, (father name) and (mother name) wish to inform you that our ward (student name) currently
resides at (home address) and is (__) years in age.

Our son/daughter is studying at The Heritage School, Rohini in (__) standard. Being the parents, we
have authorized the school officials to make the necessary travel arrangements for his/her visit to
Geneva from 13th to 20th October, 2019

We have no objections in sending our son/daughter for the Study tour to Geneva, Switzerland for 8
days with other students and teachers of the school. We also certify that on completion of the tour
our son/daughter will return to India as per the schedule.

We certify that if our ward fails to comply with the above mentioned conditions and the terms
mentioned in the application form, we will be held liable for the legal implications.

(Father Name & Signature) (Mother Name & Signature)

To,

The Consular officer,

Embassy of Switzerland in New Delhi
Nyaya Marg, Chanakyapuri
New Delhi – 110021
Tel.: (+91 11) 4995 9500
Fax: (+91 11) 4995 9509

We, (Full name of both parents) are the parents of (student name) born on (DOB), passport number
(number of passport), travelling to Geneva, Switzerland for the science camp.

We give our consent for the aforementioned child to travel to Geneva, Switzerland, departing on 13th
October, 2017 and returning on 20th October, 2019.

We have no objection in sending our ward for this educational programme with other students and
teacher of his/her school. Any questions regarding this consent can be directed to us using the following
contact information:

FULL NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
MOBILE:
EMAIL:
Thank you for your assistance in the matter.

Sincerely

Father Name & Signature

Mother Name & Signature

(notary stamp)
 Authorization

I, ____________________________, hereby authorize

Mr/Mrs/Ms __________________________, of
______________________(company/travel agency), to
submit/collect my visa application.

I declare that I am fully aware that with my signature on the

visa application form I take the responsibility for the
indications in the application form as well as for the
documents submitted.

I declare that I have read and understood the relevant

paragraphs on page 4 of the visa application form which
explain my rights and obligations.

Further I confirm herewith that

my phone number is ___________________,
my mobile phone number is ______________________
and my email address is _______________________.

Place & date: ______________________________

_____________________________
(Signature)

Enclosure:
- Copy of my passport
 Affidavit of Consent for Children Travelling Abroad

To whom it may concern, I / We:

Details of Legal Guardians:

Father’s First Name:

Father’s Last Name:

Telephone and email:

Identity Proof Number issued by Government of India:

(Passport Number/ PAN Card/ Driving License/ Aadhar Card/ Voters Card)

Mother’s First Name:

Mother’s Last Name:

Telephone and email:

Identity Proof Number issued by Government of India:

(Passport Number/ PAN Card/ Driving License/ Aadhar Card/ Voters Card)

Authorized Legal Representative’s First Name:

Authorized Legal Representative’s Last Name:

Telephone and email:

Identity Proof Number issued by Government of India:

(Passport Number/ PAN Card/ Driving License/ Aadhar Card/ Voters

Card)Address:

Landline Number:
I/We am / are the parent(s), legal guardian(s) or other authorized person(s) or
organization with custody rights, access rights or parental authority over the
following child:

Child Information:

Child’s First Name:

Child’s Last Name:

Date and place of birth:

Number and date of issue of passport (if available):

Issuing authority of passport (if available):

This child has my / our consent to travel alone ☐ or This child has my / our consent
to travel with Accompanying Person:

(Teacher:1)

Name: Ms. Ritu Bhatt

Relationship to child: Teacher

Number and date of issue of passport: K2364991, 17/01/2012

Issuing authority of passport: Delhi, India

Contact Information during trip: +41 779873027

1. I hereby authorize the Child to travel with the Traveling Guardian to the
following destination(s):

1. Destination(s): Geneva, Switzerland

2. Travel dates: 13th to 20th October, 2019

3. Should it prove to be impossible to notify the Parent / Guardian of any change in

travel plans due to an emergency or unforeseen circumstances arising, I authorize
the Traveling Guardians to make such change in travel plans as the exigency of
situation may require as per decision of the Travelling Guardian.
4. Should the Traveling Guardian in his / her sole discretion deem it advisable to
make special travel arrangements for the Child to be returned home due to any
unforeseen circumstances arising, I accept full responsibility for the additional costs
which shall be incurred thereby.

5. The Parent/Guardian is aware of the risks involved in the aforesaid programme

and hereby undertakes to himself/herself bear all the losses and damages incurred
on account of the child in the course of the aforesaid programme and not to make
any claim against the travelling guardian or the school/institution on any account
whatsoever.

6. That the aforesaid travelling guardianship is only for the purpose of including
one child in the aforesaid tour programme, and our responsibility as a guardian of
the child in general including period of the aforesaid tour programme shall remain
intact

7. I indemnify the Traveling Guardian against any and all claims whatsoever and
howsoever arising.

8. I declare that I am the legal custodian of the Child and that I have legal authority
to grant travel consent to the Traveling Guardian for the Child in the above matter.

Signed at ______________________on this ______day of 2019.

SIGNATURE_____________________________ (Parent / Guardian)

SIGNATURE _____________________________(Parent / Guardian)

WITNESS 1: ___________________________

WITNESS 2: ___________________________
 UNDERTAKING / INDEMNITY BOND

We the undersigned parents/guardians of ______________________________ , studying in

Class_ ___, at The Heritage School, Rohini, herewith voluntarily submit the below under
taking:

a. We, the undersigned parents/guardian are aware that, our son/daughter is participating
in the visit/excursions off campus, which are organized by Life Lab Foundation. These
visits are scheduled during 13th to 20th October, 2019 with our full acceptance and we
will be bearing all the expenditure incurred for these visits/excursions towards travel
and other expenses from our end.
b. We agree to all the terms and conditions in the Memorandum of Understanding signed
between The Heritage School, Rohini and Life Lab Foundation. We shall ensure that
our son/daughter shall abide by the terms and conditions laid down both by the school
as well as Life Lab Foundation for the aforementioned visits. We, hereby declare and
confirm that the neither the school nor Life Lab Foundation shall be held responsible in
the event of any misfortune or accidents and/or personal injuries whether fatal or
otherwise involving our son/daughter.
c. We shall undertake full responsibility of all the consequences should any other person
or body suffer such accidents and/or personal injuries and/or damage to property as a
result of our son/daughter negligent act during the period of visit/excursion.
d. That we agree to our ward taking part in visits/excursions off campus under the
supervision of the The Heritage School, Rohini staff. We are confident that the school
will make adequate arrangements to ensure the safety and security of our ward. Despite
that if any unforeseen/untoward incident occurs during any such activity, which would
be final and binding on us, we agree to accept the final decisions of the management
and shall not directly or indirectly pressurize the management to change their decision.
e. That we shall abide by all the rules and regulations of the school. We further confirm
that the neither the school nor Life Lab Foundation shall not be held responsible for our
son/daughter misconduct or wrongdoing at all times during the period of tour and shall
obey the instructions of the faculty members who are accompanying during these visits.
f. That the the school and Life Lab Foundation reserves all rights to initiate any
disciplinary action against my ward, if during the course of the tour, he/she is found as
individual or groups knowingly or unknowingly to disobey or indulge in any activities
that will/may bring disrepute to the Institutions.

708-E, Mayur Vihart II, New Delhi- 110091

www.lifelab.org.in | contact@lifelab.org.in | +91 8377833563
We also declare that we will abide by the terms and conditions and their consequence as
stated below:

1. Alcohol and Drugs:

Any consumption or possession of alcoholic beverages or drugs is strictly prohibited
and may result in expulsion of student from the tour. The families concerned will pay
for the cost of early flights back to INDIA and the student/parent as the case may be
shall solely be responsible for any civil/criminal & other infringement of law and Life
Lab Foundation and The Heritage School, Rohini shall not bear any responsibility for
any such illegal act or infringement directly or indirectly.

2. Vandalism :
Vandalism or stealing will result in expulsion from the program unless there are
extenuating circumstances.

3. Harassment:
Any kind of harassment shall be strictly dealt with. If any teacher or staff of Life Lab
Foundation feels that any Mental or physical harassment has be done to any student,
both the school as well as Life Lab Foundation shall have the right to send the student
back to India.

4. Buddy System:
Students are required to be in groups of two or more (buddy system format) when in
shopping areas, swimming pools, sightseeing areas and during social functions.

5. Unlawful A cts :
Unlawful acts by student will result in the immediate expulsion from the tour and
appropriate punishment by Civil Authorities concerned.

6. Picture Policy:
Life Lab Foundation can publish any or all pictures, thesaurus, research, findings and
videos of student's work taken during the course of this program in any publication,
public relations, and/or advertising purposes, without limitation, reservation or any
additional compensation.

7. Transportation Liability:

708-E, Mayur Vihart II, New Delhi- 110091

www.lifelab.org.in | contact@lifelab.org.in | +91 8377833563
 Students will be transported at times during the program for field trips and other
special circumstances. While en route, the child will be under the direct supervision of
the teacher or their appointed/associated staff/driver/volunteers and will be subject to
all regulations set for the safety of the child. Participants will not hold the Life Lab
Foundation/driver, Life Lab Foundation staff, volunteers, the School or any other
person responsible for any injuries or loss of property, which may be sustained as a
direct or indirect result of this service.

8. Hotel A ccommodations:
Two Students will be accommodated in a room and with students of the same gender.

9. Flights:
We do not guarantee non-stop flights and any special airport or airline. While we
attempt to get groups their preferred airport, but can never guarantee so. Life Lab
Foundation is not responsible for schedule changes, mechanical or weather delays that
may occur.

10. Behaviour:
While travelling, participating students will be expected to abide by local laws,
including those concerning drugs or alcohol or use/possession of any harmful article(s).
They will also be responsible for any personal calls or incidental personal expenses, or
any damage done to the buses or hotels while on tour. Breaking these laws and rules
may be the grounds for being sent home early from the trip at their expense.

11. Force Majeure:

Life Lab Foundation cannot be held responsible for events beyond its control, such as
acts of God, war, terrorist activities, and incidents of political violence, civil unrest,
illness or quarantine, strikes or government restrictions. We reserve the right to cancel
any tour for any such reason, in which case, and no other case you will receive an
appropriate refund.

12. Damages:
Life Lab Foundation cannot be held responsible for loss of personal property including
money, and is not responsible for personal injury, property damage, or loss of earnings
from any event whatsoever caused by hotels, railways, airlines and all sub-contracted
services.. All parties agree that in the event of legal action concerning this agreement, all
litigation shall be brought only in Delhi Court in India and that such litigation shall be
decided pursuant to the laws of INDIA.

708-E, Mayur Vihart II, New Delhi- 110091

www.lifelab.org.in | contact@lifelab.org.in | +91 8377833563
 13. Limited Seats:
There is limited space available in the program. A space is not held or secured until a
completed registration form and written consent is received with full payments for the
program.

14. Legal Obligation:

In case any student, unlawfully, attempts to or flees away from the group, then his case
would be reported to the nearest law authorities and a formal police report will be
lodged against him. Also in the above mentioned scenario any member from the school
management or Life Lab Foundation would not be responsible for the illicit action of
the student by any court in India and abroad.

15. Governing Law:

Students shall ensure that they comply with all local laws. If any student is found doing
any act illegally, he/she can be prosecuted under the visiting Country Law. The School
and Life Lab Foundation shall bear no responsibility of the same.

We hereby certify that we are signing this undertaking in sound mind and disposition and
without any dures s or coercion.

This undertaking is made on:

Date:
___________________________________________________________________________________

Name & Signature of the Parent/Guardian:

_____________________________________________________

708-E, Mayur Vihart II, New Delhi- 110091

www.lifelab.org.in | contact@lifelab.org.in | +91 8377833563
INDEMNITY FORM

I have read the details of the study visit to Geneva, Switzerland being organised by Life Lab
Foundation from 14th to 20th October, 2019.

My ward _____________________of class _______________ has voluntarily enrolled for

participating in the group representing The Heritage School, Rohini in the Innovation Camp.

I fully understand the inherent challenges and risks associated with the participation in the
trip and the related logistics of travel and stay during the 8 days at the respective location.

I have understood and filled this form and I sign below voluntarily:

Name of Parent/Guardian __________________________________________________

Name of the pupil ________________________________________________________

Signature of the Parent/Guardian ____________________________________________

Date ________________________________________________________

Father’s Name ___________________________________________________

Signature ________________________________________________________

Mother’s Name ___________________________________________________

Signature _________________________________________________________

708-E, Mayur Vihart II, New Delhi- 110091

www.lifelab.org.in | contact@lifelab.org.in | +91 8377833563