Format No.

ACD 21
KLNCIT INDUSTRIAL VISIT CONSENT FORM Issue No. 01
Rev.No. 00

Name : Year/Sec :

Roll No :

Name of the industry & address :

Date : ____________ to ____________

Departure Point: Time:

Place of Stay :

Return Station: __________________________Time:

Amount Collected:

Industrial Visit In-charge: HOD

Student’s Declaration

I,___________________________________ Year_________ student of this college fully

know that I am accompanying the Educational/Industrial Tour/Visit along with other
students and staff on my own accord and if outward incident (s)happens to me either of
my own action or by others, the Staff, the Principal and Management will not be held
responsible for the same.

Date: Signature of the Student

_______________________________________________________________________

I agree to send my Son/Daughter Mr./Ms______________________________________

who is staying in Hostel/Outside/with me for the tour programme.

Date: Parent/Guadian/Warden