SHARDA UNIVERSITY

Consent Form for Students and Parents/Guardians

UGC has issued guidelines (D.O.14-8/2020(CPP-II) dated 5th November 2020 for reopening the
Universities and Colleges Post Lockdown due to COVID-19 Pandemic. The students may visit
the University, in areas outside the Containment Zones only. This form is to take consent of
students and parents/guardians. Based on receipt of data through consent forms , Sharda
University will plan for offline/online or blended mode of classes. Hence, all students and
parents are requested to submit the duly filled and signed consent form latest by 10th December
2020 for further planning.

Signing this agreement, I acknowledge the contagious nature of COVID-19, risk of exposure to
COVID-19 during my presence in the University. The University is taking measures to provide a
safe community to its faculty, staff and students. However, I understand that the University can't
prevent all risk of infection. I acknowledge that the University has done its best to implement
recommended guidelines and put in place preventative measures to reduce the spread of COVID-
19; however, the University cannot guarantee that I will not become infected with COVID-19. I
understand and consent to submit and comply with all SOPs, any testing, health monitoring and
contact tracing protocols that the University has determined are prudent to maintain a safe
campus environment.

Name of student Neha Srivastava

School Name School of nursing science and research
Programme Name M.Sc. Nursing 1st year
Year/Semester 2020
Gender: female/male Female
Name of parents Shobha Rani Srivastava
Mobile number 9999374421
Email Id Neha90srivastava@gmail.com
Residential address 29/38, street no.-11 , 60feet road vishwas nagar
Shahdara delhi-32
Hostel requirement: yes/no No
Are you willing to send your ward to university on NO
voluntary basis for taking physical classes-yes/no I Shobha rani is not allowed to my daughter for
physical classes due to COVID-19 issues and I m
suffered from diabetes and in my family 9months
old baby is there so it is not safe for us that’s why
I am not allowed to my daughter for physical
classes. I request to nursing department please
continue the online classes for my daughter.

Neha Shobha rani

Signature of student Signature of parents