legally binding Agreement, Release, Liability Waiver, and Assumption of Risk upon my signature.
I understand that a Homestay placement is a placement in a private family home and includes a private room, bathing facilities, and a
place to study. The Homestay family provides necessary household items such as linens and towels. The student's room is
furnished, including a bed/bedding, desk or table, lamp dresser, and closet. In the Homestay with Food Plan, the Homestay family
is responsible for providing food for meals and snacks seven days a week. I may also choose a Homestay without Food Plan, and
agree to purchase, prepare all my own food and clean up afterwards.
I understand that I’m obliged to follow the rules of the Homestay family. All members of the Homestay family will be proficient in
English and will only speak English when I/the student, am present. The primary form of transportation for I/the student is the city
bus; however, the Homestay family may occasionally offer me a ride in their personal vehicles.
I consent to my placement in a Homestay family. Additionally, I understand and agree that there may be modifications in my
Homestay placement. I the student, agree to release the STATE OF WASHINGTON, Community Colleges of Spokane (CCS), the
Homestay families, and their officers, agents, employees, agencies, and departments from any responsibility and liability for changing
who will be assigned as the Homestay family prior to or after my arrival in the United States, placement in more than one Homestay
family or denial of placement if an appropriate Homestay family is not available."
Medical
I, the student agree to purchase and maintain adequate medical insurance and personal liability insurance on my personal
belongings while I attend CCS. The medical insurance shall comply with any requirements mandated by the U.S. Visa Program. I
agree and understand that CCS assumes no responsibility for verifying the medical insurance standards of coverage if purchased
outside the CCS Lewer plan. I agree and understand that CCS assumes no responsibility to verify the purchase/adequacy of my
personal liability insurance.
I authorize the Homestay family to take whatever action they feel is reasonably warranted to obtain medical and dental attention for
myself during the period in which I live with the homestay family. This authority and permission includes, but is not limited to the
following: medical exams, testing, x-rays, anesthetic, surgical and hospital care and treatment, medical procedures, and treatment to
be performed for me by a licensed health care provider, or hospital when, in the sole discretion of the attending health care provider,
such care, treatment and procedures are immediately necessary or advisable in the interest of my health and well-being, and it’s not
advisable to take time to contact family members in advance. Under the circumstances set forth above, I elect to not be informed in
advance of the nature and character of the proposed treatment, its anticipated results, possible alternatives, and risks, complications
and anticipated benefits involved in the proposed treatment and the alternative forms of the treatment, including non-treatment.
I further grant permission for the health care treatment providers, the homestay family, and CCS to release information regarding me
to health care providers and facilities who are engaged in providing health care to me child under these circumstances.
I, the student agree to be financially responsible for the costs of all medical and dental care and treatment obtained or provided to me
during my attendance at CCS and stay with the Homestay family. I and my heirs, assigns, or other successors in interest agree to
release the STATE OF WASHINGTON, Community Colleges of Spokane (CCS), the Homestay families, and their officers, agents,
employees, agencies, and departments from any responsibility or liability for any medical or dental related costs.
Additional Costs:
I agree to reimburse my Homestay for repairs/costs incurred by me in the event of damage to the Homestay family home or property.
Activities, Travel and Trips:
I understand and acknowledge that there is a risk of injury to me by my participation in trips and activities with my Homestay family.
I further understand that it is voluntary for me to participate in trips and activities with the Homestay family and that CCS and the
Homestay program do not require my participation. I hereby release the Homestay Family, CCS and the State of Washington, their
employees, officers, agents, and trustees, and waive any and all right and claims for damages from any and all injures that I may
suffer as a result of my participation in trips and/or activities.
I agree to hold harmless and indemnify the Homestay Family, CCS and the State of Washington, their employees, officers, agents,
and trustees for any action, claim, or proceeding initiated as a result of any injury suffered by me or any third party through my
participation in any trips and/or activities. Typically these activities may include, but are not limited to: transport in Homestay family
member vehicles to shop, commute to/from school, dining out, community/religious events, family recreational, vacation activities etc.