COVID-19 INDEMNITY
FORM
(This document
contains 3 printed pages)
I, ...................................... (Parent/Legal guardian) of (Name of the student) ................. ERP ID. ................. Course B.PHARM Branch PHARMACY Year 2nd.
Acknowledge the contagious and unpredictable nature of the coronavirus disease (COVID-19) and I hereby voluntarily execute this COVID-19 Indemnity Form.
I
understand that the College has put in place preventive measures and other
protocols to minimize the spread of COVID-19 but, even so, the student's return
to the College may subject him to the risk of being infected. It is well known
that the COVID virus is ubiquitous in the atmosphere all over India. Therefore,
the risk of exposure is everywhere, whether in College or at home or in the
market or anywhere else. However, the college will endeavor to maintain higher
standards and keep the College as a contained zone so that in College there is
a lesser risk to potential exposure than any other place.
I also understand that the student is under no obligation to attend the College if I and/or the student have any safety concerns.
Notwithstanding
this, I have freely consented to the Student's return to the College fully
aware
and
on the voluntary assumption of the aforementioned risk.
I
undertake to follow and to impress on the Student to follow, all instructions,
and requirements of the College (as may be amended by the College from time to
time) due to the College's response to the COVID-19 pandemic to limit any
transmissions of COVD-19; and as required by any Regulations issued by the
Government under the Disaster Management Act, 2005 (Act No, 53 of 2005).
I hereby agree to unconditionally indemnify and hold harmless the College against any claim including but not limited to damages or expenses and/or from any other claims, costs or other liability or expense of any nature whatsoever (whether direct, consequential or otherwise for death, illness or other loss or harm sustained by the Student), arising out of or in connection with the transmission of COVID-19 at College.
I hereby unconditionally, waive and discharge any and all claims, suits, or proceeding that I, or the Student, may have against the College with respect to death, illness, or any other loss or harm, arising out of, resulting from, relating to or in connection with the transmission of COVID-19 at College.
I
understand that this is an important legal document indemnifying the College
against the transmission of COVID-19 on the college's premises and that by
signing this Indemnity, I hereby waive any and all legal rights that may exist
and that I may otherwise have against the College and others.
NAME
OF PARENT/LEGAL GUARDIAN : .............
PERMANENT ADDRESS:
PRESENT ADDRESS:
MOBILE NO; ...............................
TRAVEL
HISTORY OF THE STUDENT (last 3 weeks) (DOMESTIC & INTERNATIONAL):
___________________NO_____________________
TRAVEL
HISTORY OF THE FAMILY (last 3 weeks) (DOMESTIC & INTERNATIONAL):
__________NO_____________________
HISTORY OF COVID INFECTION OF THE STUDENT: _________NO_______
OF COVID HISTORY INFECTION OF THE FAMILY: ____________NO_________
ZONE OF ORIGIN : GREEN
I/WE
DO HEREBY DECLARE AND CERTIFY THAT I/WE HAVE READ THIS DOCUMENT AND I/WE FULLY
UNDERSTAND ITS CONTENT, I AM/WE ARE AWARE THAT THIS IS AN INDEMNITY AND RELEASE
OF LIABILITY AND I/WE SIGN IT OF MY OWN FREE WILL.
Signed on Date: _________(DD/MM/20__
Parent/Guardian
Accepted by the College on Date :
______(DD/MM/20
* The governing law and alternative dispute
resolution provisions of the parent contract (as amended from time to time)
shall apply mutatis mutandis to this indemnity.
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