-

-- --- -- - -~ -- -- - -- -- --- ----- ·- - . - ·- - . . ~- - .

~B S INT ER NA TIO NA L SCHOOL

•
I
,~ INTERNATIONAL (RECOGNISED AND AFFILIATED TO CBSEI
. ..;.; . SCHOOL
, Sector-11, Dwarka, New Delhl-110075
T : +9111 45312000
E : lnfo@mbslntamatlonal.edu.ln
W : www.mbslntarnatlonal.edu.ln

Annexure-1
SESSION: 20 _- 20 _

UNDERTAKING FOR ESCORTED WALKER

________________
_ _ _ Par ent / Guardian
of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ studying in class
& Section . I acknowledge that my child will be
an escorted walker. I give the consent to school
to let my child leave the
school premises with an accompanying adult Ms.
/ Mr. _ _ _ _ _ _ __
(Father/ Mo the r/ Guardian) at the time of disp
ersal. I understand the risks
involved in this and am willing to take the resp
onsibility for the same. The
school will not.be held responsible in the unfortun
ate event and any mishap .
Any questions regarding this consent can
be directed to me at the
contact information mentioned below.

Signature of Parent : _ _ _ _ _ _ _ _ __

Signature of Guardian : _ _ _ _ _ _ _ _
_
Contact Number :
--- --------
E-Mail ID:
-- -- -- -- -- -- -
Photo of Guardian

Not e:
Paste a photograph of the guardian if the guardia
n is accompanying the child.