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MUJI/4 |
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MUJI/4 |
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MOI UNIVERSITY |
| Student Details | |
| Name Of Student |
.............................................................. |
| Admission Number | ................................. |
| Course Accepted For | .............................................................. |
|
Emergency Operations |
|
This applies to Students who are Minors. Approval of your parents (or guardians) is required for the Vice-Chancellor of the University to give consent on their behalf for an emergency operation to be carried out on you should a situation calling for such an operation arise. Parents (guardians) are therefore required to complete the consent from below if you are under 18 years of age. |
| Form of Consent |
| I agree that the Vice-Chancellor of Moi University may consent to an emergency operation being performed on ................................. (insert name) if it has not proved possible to contact me in time. |
| Name of Parent (Guardian) | ........................................................... | ||
| Relationship | ........................................................... | ||
| Address | ........................................................... | ||
| ............................................................ | |||
| Signed | ................................. | Date | ................................. |