Fillable Global Education APARTMENT TRANSITION FOR MINORS (Spokane Community College)

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Global Education APARTMENT TRANSITION FOR MINORS (Spokane Community College)

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CCS 5019 (Rev. 12/19)
Marketing and Public Relations
Global Education
APARTMENT TRANSITION FOR MINORS
Spokane Falls Community College • Spokane Community College
MS 3011 3410 W Fort George Wright Drive • Spokane WA 99224-5288 USA
509-533-4113 • FAX: 509-533-3237
International Homestay Program
Email completed form and all documentation to InternationalHomestay@ccs.spokane.edu
for approval by the Manager of Immigration and Student Success. Questions? Call: 509-533-4113
This form is to exempt minor students from having to live with a CCS Homestay Family due to them
becoming age 18 during or immediately after summer or winter vacation, and who need to apply for
an apartment during this transition period, OR, for students who turn 18 immediately following the
start of their initial quarter. Students who meet the following criteria may waive, or move out of the
Homestay Program, after May 1st, or Nov 1st, depending on when the student turns 18.
1. Turn 18 between May 1 and October 31; return to home country for the summer vacation.
2. Turn 18 between November 1 and January 31.
3. New student arriving fall quarter and turning 18 prior to October 31.
Students must provide the following:
1) A signed letter from their parent(s)/guardian(s) which gives the student very specific permission for
them to waive Homestay, or move from Homestay into rental housing, as a 17-year-old. Letter must be
sent from the parent directly, or through the Student's agent. (Note: Translation can be done by CCS.)
2) A copy of the airline ticket for departure from Spokane before summer or winter vacation start date, if
required by CCS Homestay staff.
Date of travel to home country
Return date
Return flight
3) This form, signed by parent(s)/guardian(s)
4) Confirmation of 30-day notice given to their current Homestay Family, if currently residing in Homestay.
Current Homestay Family Name
30-Day Notice was given on (date)
Student name
Country
Date of Birth
Email
Student ID#
Cell phone
Parent(s)/Guardian(s)
Parent email
Parent phone #
CCS 5019 (Rev. 12/19)
Marketing and Public Relations
PLEASE READ AND UNDERSTAND THE FOLLOWING BEFORE SIGNING
AS IT INCLUDES CONTRACTUAL PROVISIONS AND HAS LEGAL SIGNIFICANCE
By signing below, I acknowledge that I am requesting an exception to the CCS Homestay Program, which
requires minors to be housed in approved host homes until the student’s 18th birthday. We accept all
responsibility for the student's housing, any legally binding contracts the student signs, and for understanding all
financial responsibilities to any housing outside the CCS Homestay Program. Student will pay all outstanding
Homestay fees and damages prior to leaving their Homestay Family home, if applicable.
PARENTAL ASSUMPTION OF RISK, RELEASE OF CLAIMS AND AGREEMENT TO INDEMNIFY
We, the Parent(s), identified above, understand the hazards and risks involved in this decision. We voluntarily
agree to assume these hazards and risks and to waive and release any and all claims we may have against
Homestay Families, the State of Washington, CCS, SFCC, SCC, and their officers, agents, employees, and
departments and the host institutions abroad including but not limited to claims, demands, obligations, actions,
causes of action regarding Student for any injury, illness, disability, accident, wrongful death, loss of services
and support, loss of consortium, property damage, and/or property loss.
We, the parent(s), identified above also agree to indemnify the State of Washington, CCS, SFCC and SCC, and
their officers, agents employees, departments and the Homestay Family with regard to any financial obligations,
liabilities, or expenses that may be incurred as a result of any injury, illness, disability, accident; wrongful death,
loss of services and support, loss of consortium; property damage; and/or property loss including but not limited
to, emergency transport; emergency medical services; medical treatment; rehabilitation; lost wages; lost or
damaged property and any financial obligations, liabilities or expenses that may be incurred as a result of any
damage or loss to person(s) or property caused by the Student. We, the parent(s) identified above, have
reviewed and understand the hazards and risks and have advised Student to take appropriate actions and to
govern themselves accordingly. We are also aware that certain insurance companies offer insurance against
some perils and/or regarding loss and/or damage to property and are aware that the US Department of
Homeland Security has specific requirements for F-1 students to have full financial capacity to prevent them
becoming a burden of the State.
BY SIGNING THIS AGREEMENT, I CERTIFY I AM THE STUDENT APPLICANT IDENTIFIED AT THE TOP OF
THIS DOCUMENT. I HAVE READ, UNDERSTAND, AND VOLUNTARILY AGREE TO ALL OF THE TERMS
AND CONDITIONS SET FORTH IN THIS AGREEMENT.
Name of Student (please print):
Signature of Student:
Date
BY SIGNING THIS AGREEMENT, I/WE CERTIFY THAT I/WE ARE THE PARENT(S)/GUARDIAN(S)
IDENTIFIED AT THE TOP OF THIS DOCUMENT. I/WE HAVE READ, UNDERSTAND, AND VOLUNTARILY
AGREE TO ALL OF THE TERMS AND CONDITIONS SET FORTH AND ACKNOWLEDGE THE HAZARDS
AND RISKS, RESPONSIBILITIES, RELEASE OF LIABILITY, AND AGREEMENT TO INDEMNIFY.
Name of Parent/Guardian (please print):
Signature of Parent/Guardian:
Date
Name of Parent/Guardian (please print):
Signature of Parent/Guardian:
Date
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Global Education APARTMENT TRANSITION FOR MINORS (Spokane Community College)

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Completed 8 October 2020

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