Student Host Agreement

STUDENT HOST AGREEMENT

Parties and Program

Host Family Name:

Student Name:

Date of Birth:    Student ID:

Recitals and Term

This Student Host Agreement ("Agreement") is entered into between the Host Family named above (Host) and the Program Provider named above (Provider) for placement of the Student identified above. The Host agrees to provide residential accommodation and related services under the terms set forth below for the period commencing on and ending on , unless earlier terminated in accordance with this Agreement.

Host Family Obligations

The Host will provide the Student with a safe, habitable private or shared bedroom, reasonable access to common areas, and daily meals as described below. The Host affirms that the home meets local health and safety standards and will immediately notify Provider of any conditions that may endanger the Student.

Meals provided:   Transportation provided for school/extracurriculars:

Student Responsibilities

The Student agrees to comply with Host family rules, attend school as required by Provider, maintain personal hygiene and responsible behavior, and respect Host property. The Student will participate in reasonable family activities and will not engage in illegal activity at the Host residence.

Emergency contact while hosted: Relationship: Phone:

Background Checks, Training, and Safety

The Host consents to and will facilitate any background checks, child safety training, and home safety inspections required by the Provider. Host confirms that all adults residing in the home have disclosed relevant convictions and will comply with Provider's screening procedures.

Host represents that the following background check documentation has been provided to Provider: criminal records check   fingerprints

Insurance, Liability and Indemnity

The Host acknowledges that Provider's insurance may not cover all incidents occurring at Host's residence. Host agrees to maintain homeowner or renter liability insurance sufficient to cover third-party claims arising during the placement. Host and Provider shall each indemnify and hold harmless the other for negligent acts or omissions by their respective agents, except to the extent caused by willful misconduct.

Fees, Stipend and Payment

If applicable, Provider will pay the Host a monthly stipend of to offset housing and meal costs. Stipend disbursement will follow the schedule:

Termination and Removal

Either party may terminate this Agreement for cause upon written notice or without cause with days' notice. Provider reserves the right to remove the Student immediately where safety or welfare concerns arise. Costs associated with early removal shall be allocated as provided in Provider policies or as otherwise agreed in writing.

Confidentiality and Use of Information

Host and Provider agree to protect the Student's personal information. Host will not disclose student educational records, medical information, or other sensitive information except as required by law or authorized in writing by the Student or Parent/Guardian.

Acknowledgments and Certification

By signing below, Host and Provider certify that they have read, understand, and will comply with the terms of this Agreement. Host certifies that all information provided to Provider is true and complete. Provider certifies that it will monitor placement and respond to welfare concerns in accordance with its policies.

Host acknowledges receipt of Provider's emergency procedures and confirms that Host will follow those procedures and promptly report incidents to Provider.

Consents

Host consents to photographs for administrative use:   Host consents to emergency medical treatment for Student if Parent/Guardian cannot be reached:

Governing Law

This Agreement shall be governed by the laws of the state or jurisdiction in which the Host residence is located:

Additional provisions or exceptions (if any):

Sign Now