F-2-59-8-9
JOMO KENYATTA UNIVERSITY
OF
AGRICULTURE AND TECHNOLOGY
P.O. BOX 62000-00200, CITY SQUARE, NAIROBI, KENYA. TELEPHONE: (067) 52711/52181-4. FAX: 52164, THIKA
Office of the Registrar (Academic Affairs)
E-Mail: [email protected]
EMERGENCY OPERATIONS
Name of Student: ...............................................................................................................................
University Registration Number: ...........................................................................................................
Course Accepted for: .............................................................................................................................
Approval of your parent or (guardian) 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 arises. Parents (Guardians) are therefore required to complete the consent form below.
FORM OF CONSENT
I agree that the Vice-Chancellor of the Jomo Kenyatta University of Agriculture and Technology may
consent to any emergency operation being performed
on:............................................................................................................................................(Insert Name
of Student) if it has not proved possible to contact me in time.
Name (Parent/Guardian):.......................................................................................................................
Signature:........................................................................ Relationship: ................................................
Telephone No(s): ...................................................................................................................................
E-Mail:................................................................................ Date: ...............................................
JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified
Setting Trends in Higher Education, Research, Innovation and Entrepreneurship
