RCIP - Friendship Family Form (family)

RCIP - Friendship Family Program

Please complete this form if you are interested in being a Friendship Family for an international student or students at Ball State University

Friendship Families DO NOT provide financial assistance to the student.

During the placement process, a Rinker Center staff member may contact you with further questions to help facilitate a match with a Friendship Family student applicant.

The Rinker Center makes every attempt to match Friendship Family applicants with international students based on the completed Friendship Family application compatibility questions. However, the Friendship Family Program is not able to guarantee a match with a student from a specific country, studying a specific major or who speaks a specific language. We ask for your flexibility on these criteria, if possible.

Items with an * indicate a required field.

Contact Information:
First Name *
Last Name *
Other adults in household
Please list approximate ages of children
Address Line 1 *
Address Line 2
City
State
Zip
Phone *
Email *
Are you a current student or employee at Ball State University? *	Yes No
If yes, what year or profession?
Do you or does someone in your household smoke? *	Yes No
List any pets that you may have
What are your interests, hobbies, and/or activities? *

Important information not previously listed which may affect placement of students


Preferred Student Information
How many students would you like to host? *
I would like to have a student here on:
Gender *
Major
Country and/or language
Please indicate if you will accept a student with cultural or medical diet restrictions	Yes No

Reference Information (required)
Contact Name *
You must provide a reference.
Non-Family Relationship *
Phone *
Email *
Typing your name here will constitute your signature and your agreement to participate according to the terms in the disclaimer. *

Waiver of Liability, Assumption of Risk, and Indemnity Agreement Waiver:

In consideration of being permitted to participate in Ball State University’s Friendship Family Program, and all activities incidental thereto however the same may occur and for whatever period said activity may continue (herein after referred to as “Activity”), I, for myself, for my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Ball State University’s Rinker Center for International Programs, the Friendship Student(s) assigned to my family and Ball State University and their Boards of Trustees, their officers, their directors, their employees, their agents, their volunteers, their members and assigns, and any and all other participants in said Activity and any and all Ball State University students and/or any and all Ball State University Alumni and/or any and all Ball State University faculty and staff from liability from any and all claims resulting in personal injury, accidents or illnesses (including death), and property loss, regardless of fault, arising from, but not limited to, participating in the Activity.

Assumption of Risks:

Participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another.

I have read the previous paragraph and I know, understand, and appreciate these and other risks that are inherent in the Activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless:

I also agree to INDEMNIFY AND HOLD Ball State University’s Rinker Center for International Programs, the Friendship Student(s) assigned to my family and Ball State University and their Boards of Trustees, their officers, their directors, their employees, their agents, their volunteers, their members and assigns, and any and all other participants in said Activity and any and all Ball State University students and/or any and all Ball State University Alumni and/or any and all Ball State University faculty and staff HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my own/my daughter’s/my son’s/the minor’s, of whom I am Guardian, involvement in said Activity and to reimburse them for any such expenses incurred.

Severability:

The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Indiana and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding:

I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

You will be required to sign your name on the last question of the Friendship Family Form if you accept this disclaimer.