Government Polytechnic, Mandi Adampur, Hisar, Haryana
Civil Engineering Department
Undertaking Form for Survey Camp
I, _____________________________ (S/D/o__________________________) student of
3 - Year Diploma( Civil Engineering 5 th Semester) class roll no. __________________is
going for survey camp at Waknaghat,Solan , Himachal Pradesh) from _________________to
________________with the full knowledge of my parents/guardian, and
1. I’ll abide by all the rules and regulations of the survey camp and instructions given
from time to time during the camp.
2. In case, I breach the discipline during Survey Camp, I’ll be expelled from the camp.
3. I’ll be directly responsible for any untoward happening during the camp duration.
4. I will carry my I-Card during the entire period of survey camp.
5. Before proceeding for survey camp, I will provide a medical fitness certificate
indicating that I am fit enough to stay and work in a hilly area at an altitude of 2100
meter above MSL for 12 days.
6. I will not participate in any type of tracking or swimming activity during the survey
camp.
Name of Student
Class Roll No.
University Roll No.
Contact No. of
Student
Signature of
Student
Signature of
Parent/Guardian
Name of
Parent/Guardian
Contact No. of
Parent/Guardian
Email id of
Parent/Guardian
Address of
Parent/Guardian