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Self-Declaration / Consent Form

I __________________________________ S/D/o Sh. _________________________ resident of


_______________________________ Tehsil ________________ District ____________ hereby declare
that my son/daughter _________________________ is a student of ____________________ semester of
_________________ (Program) bearing Registration No. _______________ of Lala Lajpat Rai
Institute of Nursing Education, Gulab Devi Hospital, Jalandhar.

I am fully aware of the instructions / guidelines issued by Govt. /Health Department regarding
COVID-19 and my son/ daughter is also well aware of these instructions / guidelines and the same will be
followed accordingly.

Now, as per the guidelines issued by Govt. / Health Department regarding the physical presence
of students in educational institutions, I give my consent to send my son/ daughter to attend on-campus
classes in the Institute.

Further, I give my consent for the stay of my son / daughter in institute hostel with the above said
terms and conditions, in case my son / daughter opts for the hostel facility.

(Signature of Parents)

Mob. No.

Date:

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