Residence Hall Guest and Visitor Safety Acknowledgement
This form is to be completed by the guest/visitor ONLY.
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 [www.salem.edu/readystrong/healthsafety/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 *
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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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