BETHANY COLLEGE

Acknowledgment of SHARED RESPONSIBILITY, ASSUMPTION OF RISKS,

And UNIQUE CIRCUMSTANCES OF COVID-19 Pandemic: 

2021

The novel coronavirus, COVID-19 and its variants (any reference to COVID-19 hereinafter includes any variant), is a highly infectious and extremely contagious virus that can lead to severe illness and/or death and has been declared by the World Health Organization to be a global pandemic. I acknowledge the contagious nature of COVID-19, the fact that it can be difficult to identify in another, and/or that some people may exhibit no symptoms but spread COVID-19.

I acknowledge that the college is especially focused on the health and well-being of all members of its community, a residential campus, and the surrounding community, and has expressed an expectation that students and employees obtain the COVID vaccine. While currently approved by the FDA on an emergency approval basis to expedite manufacturing, the college believes the efficacy and benefits of the vaccine outweigh the risks and potential reactions but does not discount the risks and respects individual autonomy. However, I acknowledge if I choose not to be vaccinated, I will be subject to college protocol, while on Bethany College campus or participating in Bethany College activities or athletics including but not limited to wearing a mask, quarantine or isolation and other protocol that may change depending on health guidance and metrics in the campus and surrounding community.

I acknowledge, the college offered to provide a vaccination, without any administrative fee, on campus for my convenience, subject to risks stated in a separate written waiver provided by the college campus nurse at the time of the injection(s). Nonetheless, I understand an inherent risk of exposure to COVID-19 or a variant exists in any public place where people are present, such as Bethany College. I further understand these risks are affected by my adherence to health protocol and my vaccination status.

I agree that if I am exhibiting symptoms that are consistent with COVID-19 or a variant (which might change), I will seek advice from Bethany College Health Services, or a medical provider, immediately.

In the event I become knowingly exposed, infected, or symptomatic while away from Bethany College, and I plan to return to Bethany College campus, I agree to notify Bethany Health Services and, if appropriate, my RA and Coach and agree to quarantine or isolate upon return to campus until Health Services or administration involved in COVID response provides further instruction.

I understand if I become infected with COVID-19 or a variant, and remain on campus, I will follow self care instructions of Health Services and/or, if diagnosed or treated through separate or independent medical consultation, I will notify and share any discharge paperwork and/or test results and/or sign a waiver so Health Services can participate in my care and recovery while on campus. I will answer calls, text, and emails, and attend telehealth appointments to keep Health Services apprised of my current health status. If I do not do so, I understand staff may key into my room to check on my wellbeing. I understand that if I live off-campus, Health Services will not visit me at my residence but will provide reasonable follow up by phone, text, telehealth or email. I acknowledge Bethany College is not responsible for injury, consequence, death, or impairment, for which it did not have reasonable notice.

I understand that Bethany College representatives, faculty, staff and/or administrators cannot eliminate all of the risks of exposure to COVID-19 on Bethany College campus, or any buildings thereon. I voluntarily assume all risks related to exposure to COVID-19. I understand that the risk of becoming exposed to or infected by COVID-19 at Bethany College may result from the omissions or negligence of myself and others, including, but not limited to, representative, faculty, staff, administrators, trustees, agents, contractors, volunteers, and students of Bethany College. I am voluntarily moving to or returning to Bethany College and am aware of the risks of acquiring COVID-19 or a variant, the potential results of infection, and voluntarily assume all risks.

I understand, as a member of this campus, that I share in the responsibility of helping to minimize the risk of COVID-19 infection (or any other spread of disease) at Bethany College; and I understand and agree to cooperate and comply with any and all health protocol, communicated by campus, and understand these protocol may change and it is my responsibility to stay informed. I understand Bethany College will communicate these health protocols, recommendations or requirements to students by Bethany email, Bethany website (COVID tab), or Bethany phone application, Swede Safe. I understand that failing to comply with these rules and precautions is a violation of the Bethany College Community Standards and that failing to comply could subject me to warnings, discipline and other sanctions.

I understand that the college’s operations and face-to face-instruction may be suspended, interrupted, modified, or altered due to events-- such as acts of God, force majeure, government mandate, or order of state or county health director, as it relates to COVID-19 or its variants--such college instruction, and supportive services, tailored within the parameters determined by the above-mentioned event(s), will not deviate from the college’s pedagogical standards developed to meet individual course objectives and course outcomes. These standards, objectives, outcomes, and supportive services offered by the college will continue to serve the best interest of students, meaning a change in delivery will not warrant a refund of tuition, room and board, or other fees.

By signing this agreement, I also acknowledge that I have relied instead on my own judgment as to whether to undertake the risks and not any promises or representations made to me by Bethany College.

I voluntarily assume full responsibility for any and all risks of illness or injury associated with my exposure to COVID-19. I completely absolve Bethany College, its trustees, officers, faculty, staff, students, agents, and contractors of any and all legal or financial responsibility, including, but not limited to, any personal injury, disability, illness, damage, or death from exposure to COVID-19, whether such exposure occurs, during or after my move or return to the campus.

Also, I agree, on behalf of myself, my personal representatives and heirs, not to make any type of legal or equitable claim on Bethany College, or any of its trustees, officers, employees, agents or contractors with respect to any exposure I may have to COVID-19, whether or not it arises through the negligence, omission, or default of anyone affiliated with Bethany College, including fellow students. I further agree that if any such claim is made, I will indemnify and defend Bethany College with respect to any such claim.

I HAVE READ AND UNDERSTAND THE ABOVE AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. THIS AGREEMENT SHALL BE BINDING UPON ME AND MY HEIRS, LEGAL REPRESENTATIVES, AND ASSIGNS, AND SHALL INURE TO THE BENEFIT OF THE COMPANY AND THEIR SUCCESSORS AND ASSIGNS.

My signature below indicates that I am at least eighteen and that I have read and understand the above.

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Disclosure of Information Protected by the Family Educational Rights and Privacy Act by Bethany College: 

This provides permission for disclosure only to public health officials, and/or law enforcement officials, trained medical personnel, college health services or college administration when such information is necessary to make accommodations because of COVID-19 or a health concern related to COVID-19 and/or if necessary to protect the health or safety of students or other individuals.

I understand that my general health information submitted through an online daily health self-assessment, may be accessed by Bethany college administration for the sole purpose of monitoring health concerns and mitigation related to COVID-19. I understand Bethany may share the symptoms I report in the self-assessment limited to those listed in the preceding paragraph and for the purpose of treatment or diagnosis of symptoms consistent with COVID-19.

Pursuant to the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 C.F.R. part 99), the written consent of a parent or eligible student is required before the education records of a student, or personally identifiable information contained therein, may be disclosed to a third party, unless an exception to this general requirement of written consent applies. If a student is age 18 years or older, or is enrolled in an institution of postsecondary education, he or she is an “eligible student” and must provide written consent for the disclosure of his or her education records or personally identifiable information contained therein.

I hereby agree to allow Bethany College to disclose any personally identifiable information or education records: disclosed in an online health assessment  and/or that which helps to identify my  contacts on a daily basis in response to a health emergency or to intervene to avoid what could be an impending health emergency, to public health officials, and/or law enforcement officials, trained medical personnel, college health services or college administration when such information is necessary to make accommodations because of COVID-19 or a health concern related to COVID-19 and/or if necessary to protect the health or safety of students or other individuals.

Note: You may withdraw your FERPA consent to share this specific information at any time. A request to withdraw your consent should be submitted in writing and signed. Signature of Parent, Guardian, or Eligible Student

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