Host Family Agreement

Host Family Agreement
Host Family Name:*
City:*
State:*
Host Family's Primary Email:*
example@example.com
Does your family agree to provide a loving environment and expect your new son/daughter to accept responsibilities as a true member of your family?*

YesNo
Will your family freely and willingly provide the student with room and board? This includes providing the student with his/her own bed, as well as three square meals. (The student is responsible for his/her personal expenses, such as clothing, haircuts, personal hygiene items, school supplies/fees, etc.)*

YesNo
Does your family agree to host a student without remuneration or any other sort of financial compensation?*

YesNo
Does your family agree to maintain a separate bank account and to not loan money to or accept loans from the student?*

YesNo

Do any members of your family or persons directly related to your family have a history of drug/alcohol/substance/sexual abuse,or any other habitual behavior that may endanger or jeopardize the student’s experience in any way?*

YesNo
Please explain.*
Has any member of your household ever been charged with a crime?*

YesNo
Please explain.*
Have any members of your family or persons directly related to your family been convicted of a felony?*

YesNo
Please explain.*
Has any member of your family or persons directly related to your family been convicted of a misdemeanor?*

YesNo
Please explain.*

GUNS/FIREARMS:
Do you have any guns/firearms in your home?*

YesNo
Are they properly stored according to the laws of your state?*

YesNo
Comments:
I/we understand that we must abide by ARISE's Rule #16, which states, "The student is prohibited from handling or carrying weapons of any form to include guns, knives, clubs, martial arts devices, etc. The student is NOT allowed to discharge any firearms either at a firing range or as part of a hunting trip. The student is also prohibited from simply holding a weapon to take a picture, etc. Speaking of guns, bombs or other weapons in a threatening manner or inferring that they might be used to harm others is not allowed and will not be tolerated." We also agree to follow all applicable laws for the safe and responsible use and storage of firearms.*

I/we understand.
THE USE OF SURVEILLANCE CAMERAS:

Surveillance cameras have become very common and are used by many families outside and/or inside of their home. These cameras are typically used for security purposes and/or to watch their pets and/or children. The U.S. Department of State has received reports in recent years of some incidents in which students were being recorded without their knowledge and consent; thus violating the student's privacy. Therefore, we must ask the following questions.
Do you have any surveillance cameras installed inside and/or outside of your home?*

YesNo
Where are they located?*
I/We understand that surveillance cameras/devices cannot be installed in the student's bedroom and/or bathroom.*

I/We understand.

We/I authorize ARISE to use our/my photographs and or videos without remuneration or any other sort of financial compensation. These photographs will be used to promote and publicize the organization’s programs through brochures, posters, newsletters, newspapers, websites, Internet, etc. (Please note that ARISE will not use the photos of your home that were submitted with your application in any of its promotional materials.)

YesNo
We/I agree to pick up the student at the airport upon his/her arrival in the host community and take him/her to the airport upon his/her departure. The student will arrive approximately one week prior to the start of school. ARISE does its best to arrange for the student to arrive on a Saturday before 9:00 p.m. local time if at all possible. We/I understand that there are circumstances beyond ARISE's control in which a student may not be able to arrive on a Saturday or may arrive later than 9:00 p.m. We/I also understand that once a ticket has been arranged by the student's natural parents, it cannot be changed.*

YesNo
We/I understand that all members of the host family, as well as any other individuals residing in the home who are age 18 or older, are required to undergo a criminal background check. Furthermore, we/I acknowledge that any individual living in the home who turns 18 while we are hosting the exchange student will be required to complete a background check upon their 18th birthday. We/I agree to inform ARISE if any new persons move into our home during the exchange student's stay so that necessary background checks can be arranged. (IMPORTANT NOTE: ARISE utilizes the services of Intellicorp to conduct its background checks. After submitting your application, each family member or resident in the home who is 18 years or older will receive an email from Intellicorp containing a link and instructions to complete the background check.)*

Yes, we/I understand that background checks must be completed for anyone residing in the home who is age 18 or older.
We/I certify that the interest we/I have in hosting an international student is for a purely cultural experience, and that we/I have no other motives. This application has been completed with the knowledge of all family members, and is true to the best of our/my ability. In addition, we/I agree to notify ARISE if there are any significant changes to our/my initial application (i.e., relocation, new members to the household, change in contact information, etc.). Furthermore, we/I agree to abide by all of ARISE's rules and regulations. Under no circumstances whatsoever will we/I interfere with ARISE's disciplinary actions or decisions regarding the status of our/my student.
Name of Host Parent #1:*

First NameLast Name
Signature of Host Parent #1:*

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Date

MonthDayYear
Date
Is there a second host parent in the home?*

YesNo
Name of Host Parent #2:*

First NameLast Name
Signature of Host Parent #2:*

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Date

MonthDayYear
Date
10810 N. Tatum Boulevard, Suite 102-845 Phoenix, AZ 85028 www.arise-usa.org

Toll-Free: 1-877-6-ARISE-6 Phone: (602) 641-9699 Email: info@arise-usa.org
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