Uniform Statement of Responsibility, Release and Authorization
To Participate in Community Host Program as a Student
I have indicated an interest in interacting with a volunteer host from the Rockford community to take advantage of the benefits of interacting with community members from Rockford and the United States. However, by signing this form, I also acknowledge that I am doing so on my own volition and at my own risk.
Acknowledgements. By signing below, I understand and acknowledge that:
· Rockford University uses a third-party provider called “Sterling Volunteers” to conduct background checks on potential hosts but no background check is flawless, and there will always be potential risks involved in interacting with individuals in the community.
· These activities are not official University activities and are not supervised or directed by the University, its officers, employees or agents.
· The University is not responsible for the actions of hosts participating in this program.
· I agree to maintain the mandatory student health insurance that is required by Rockford University and approved through the University’s Lang Health Center.
· I agree to maintain acceptable standards of conduct while participating in the Community Host Program activities, and I understand and agree that my participation in the Community Host Program may be terminated if I fail to maintain acceptable standards of conduct.
· I will report to the University any behavior of any host that I find to be suspicious, dangerous or offensive.
· I am free to end my participation in the Community Host Program at any time.
Release, Waiver and Indemnification Agreement.
I hereby agree to defend, indemnify and hold harmless Rockford University, its officers, employees or agents from and against any claims, demands, actions, losses or causes of action whatsoever arising out of or related to any injury to me or damage to my property while participating in this Host Program whether such claim, demand, action, loss or cause of action results from an act or omission including the negligent acts or omissions of Rockford University, its officers, employees or agents or from some other cause, whether foreseeable or unforeseeable.