KSU8

KISII UNIVERSITY
Telephone: 0720875082 P.O. Box: P.0.BOX 408 40200 KISII-KENYA

Fax: Email: acregistrar@kisiiuniversity.ac.ke

EMERGENCY OPERATIONS
PART I
a) Candidates Name MARTHA NAFULA MULINDI
First Last/Surname

Admission/Reg. No: CB20/00086/23 Birth Certificate 1803855

Course Admitted: BACHELOR OF HUMAN RESOURCE MANAGEMENT

Faculty: SCHOOL OF BUSINESS AND ECONOMICS

This applies to the students who are minors (i.e. persons under 21 years of age).

Approval of your parents (or guardians) is required for the Medical Officer of Kisii University to give
consent on their behalf, for an emergency operation to be carried out on you should a situation calling
for an operation arise. Parents (or guardians) are therefore required to complete the consent form below
if you are under 21 years of age.

FORM OF CONSENT

I Agree that the chief medical officer of KISII UNIVERSITY may consent an emergency operation
being performed on: MARTHA NAFULA MULINDI
If it is not possible to contact me on time.

Name of Parent / Guardian/ Next of Kin DICKSON MULINDI

Contact Address: Phone : 0726510851

Relationship:: Father

Signature: Date: Aug 30 2023

For More Information Contact:

KISII UNIVERSITY
P.0.BOX 408 40200 KISII-KENYA
Tel: 0720875082
E-mail: acregistrar@kisiiuniversity.ac.ke. Website: https://kisiiuniversity.ac.ke.