DELHI PUBLIC SCHOOL, MATHURA ROAD

NEW DELHI-110003

CONSENT FORM

I __________________________ father/ mother/ guardian of

______________________of class/ sec _______________, admission no. _________
agree to pick my ward from DPS Mathura Road/ allow my ward to travel on his/ her own
after the Pre-Mid-Term Exam gets over.

The dates for Pre-Mid-Term Exam for Class X are 28th June, 1st, 3rd, 5th, 8th July, 2024.

(5th subject CA and Painting exams on 9th and 10th July, 2024, after which students will
report to their classes for the remaining school hours.)

The dates for Pre-Mid-Term Exam for Class XII are 28th June, 1st, 3rd, 5th, 8th July, 2024.

Regular classes for X and XII will resume from July 9, 2024.

My ward will be carrying his/ her RFID card as directed by the school authorities.

*The student must submit the duly filled and signed consent form to the class teacher
before the commencement of the Pre-Mid-Term Exam.

*The student will be allowed to leave school only after showing the RFID card at school
gate.

Signature of Parent/ Guardian : _________________________

Name of Parent/ Guardian:

Address :

Contact No. : _

Date :