Rinker Center Friendship Family Application

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.

Background Information

Name*

Household and Personal Information

Are there children in the household?
Are you a current student or employee at Ball State?*
Do you or someone in your household smoke?*

Preferred Student Information

Please indicate if you will accept a student with cultural or medical diet restrictions

Personal Reference Information

Reference Name*

Disclaimer

Please read and sign the disclaimer below

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.

Confirmation Page

Please review the information below to confirm that all of the information is correct before submitting

Name: {$38307321-first Name} {$38307321-last Name}
Address: {$38308403 Address}
Phone: {$38308414 Phone}
Email: {$38308417 Email}
Other adults in the household? {$38307732 Other adults in the household?}
Are there children in the household? {$38307841 Are there children in the household?}
What are there ages? {$38308165 What are their ages?}
Are you a current student or employee at Ball State? {$38308422 Are you a current student or employee at Ball...}
What year or profession? {$38308438 What year or profession?}
Do you or someone in your household smoke? {$38316597 Do you or someone in your household smoke?}
List any pets you have: {$38308495 List any pets that you have}
What are your interests, hobbies and/or activities? {$38308503 What are your interests, hobbies, and/or...}
Other information: {$38308523 Please provide any other information which may...}
How many students would  you like to host? {$38308643 How many students would you like to host?}
How long would you like to host a student? {$38308675 How long would you like to host a student for?}
Gender and family preferences: {$38312944 Gender and family preferences}
Major: {$38312963 Major}
Country or Language: {$38312965 Country or Language}
Will you accept a student with cultural or medical diet restrictions? {$38312966 Please indicate if you will accept a student...}
Reference name: {$38313045-first Reference Name} {$38313045-last Reference Name}
Non-Family Relationship: {$38313051 Non-Family Relationship}
Phone: {$38313057 Phone}
Email: {$38313059 Email}
Signature: {$38313139 Typing your name here will constitute your...}