Consent Form - Mobile Phone Permission

I, _______________________ parent of ______________________ who is a student of

Class _______ Section ________ request you to allow my ward to carry Mobile phone
to school. The reason for carrying the mobile phone is
_____________________________________________________________________
___________________________. The model of the phone is ____________________
My ward uses ______________________ (School Transport / Private Transport /
Metro) as the mode of transportation.

In case, if my ward is violating any school policy with regard to the use of phone, the
school has all the rights to confiscate and take necessary action. I also assure that my
ward will not use the phone inside the school campus.

I agree to the condition that if my ward’s phone is confiscated, the phone will be re-
turned only at the end of academic year.

Name and Signature of the parent: __________________

Phone Number: __________________

Name of the sibling(s) (if any): ______________________________________

Class and Section: ___________________________________

Name of the Student ___________________________________Class /

Section__________________

Is allowed to carry the mobile phone __________________________________(Specify the

Model)

This permission is granted until______________________________________

Permission Granted by ______________________________________________ Date

_______________

School Seal
Signature with Date___________________________________