Parent Consent Form

For Excursion 2015

North South University Pharmaceutical club is organizing an event titled Excursion 2015 for batch
112, 113 and 121.

Consent from Parent or Guardian:

I hereby consent to my child to take part in the excursion on December, 2015. Any questions
regarding this consent can be directed to me using the following contact information:
Parent or Guardian Name:
Address:
Phone:
Mobile:
Email:
_________________________
Parent or Guardian Signature

Student Details:
Name of the Student:
Date of Birth:
Passport number:
Blood group:
Any allergies:

_________________________
Zaki Farhad Habib
Faculty Advisor
North South University
Pharmaceutical Club

_________________________
Jewel Banik
President
North South University
Pharmaceutical Club