Residence Hall Guest and Visitor Safety Acknowledgement
This form is to be completed by the guest/visitor ONLY.
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Email *
By completing below as a guest or visitor of Salem Academy and College, I acknowledge and agree that:

I have carefully read and agree to follow the Guest and Visitor COVID-19 Guidelines that apply during the pandemic;  

I have carefully read and agree to complete the Daily COVID-19 Screening Checklist [] on the day of my campus visit(s) to ensure I am cleared for campus entry; and

I will not enter campus if my responses to any questions on the Daily COVID-19 Screening Checklist are “Yes” on the day(s) of my scheduled campus visit(s).  In this situation, I will notify my Salem contact and reschedule my campus visit(s) after receiving clearance from Salem in accordance with the Isolation and Quarantine Requirements.

In consideration of Salem permitting me to enter campus during the COVID-19 pandemic as a guest, I assume sole responsibility for any related COVID-19 risk, loss, or damage that I may experience as a result of my visit.  

First and Last Name *
Type your name here to confirm your agreement to abide by this Guest and Visitor Safety Acknowledgement:
Contact Number *
Date of Visit *
Salem College Student Visited *
Residence Hall Visited *
*For minor visitors and guests (under 18 years of age), please print the name of the minor child and a parent or guardian signature is required.
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