Student Registration Form

Please specify your gender:

( ) -
Have you participated in the Dinner in a US Home program before?:

Are you comfortable being paired with a host of a different gender?:

Food Restrictions:




If so, please list them here, otherwise answer "N/A or None"
Do you have a fear or an allergy of Domesticated Animals:

Do you need transportation?:



Dinner in a U.S. Home
 
WAIVER and INDEMNIFICATION FORM
  

1.  EXCULPATORY CLAUSE.  In consideration for receiving permission to participate in any and all activities of Dinner in a U.S. Home (“activity”), which is sponsored by International Student Services (“sponsor”), a member of The Texas A&M University System, I hereby release, waive, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, and their members, officers, agents, volunteers, or employees (“RELEASEES” or “INDEMNITEES”) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me while participating in this activity, while traveling to and from the activity, or while on the premises owned, leased, or controlled by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES.  I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
 
2.  INDEMNITY CLAUSE.  I am fully aware that there are inherent risks to myself and others involved with this activity, including but not limited to physical and/or emotional injury caused by incidents during the host dinner, transportation to and from the host home, and emotional distress caused by the student or host, and I choose to voluntarily participate in this activity with full knowledge that the activity may be hazardous to me and my property, and to the person and property of others.  I acknowledge there may be physically strenuous activities.  I know of no medical reason why I should not participate.  I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, which may occur to myself, other participants, and third-persons as a result of my participation and conduct in this activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES.
 
3.  NO INSURANCE.  I understand that RELEASEES do not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation.  As such, I am aware that I should review my personal insurance coverage.  Sponsor does not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so sponsor, a governmental unit of the State of Texas, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance.
 
4.  BINDS HEIRS.  It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas.
 
5.  VOLUNTARY SIGNATURE.  In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement.  I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future.  For students engaging in extracurricular activities:  I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me that has a lower level of risk to me.  I further understand this is a voluntary, extracurricular activity; therefore it is not required for me to obtain college credits and not participating in this activity will in no way hinder my ability to obtain a degree from the university. 
 
SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT.
 


I understand and agree to the terms listed above. I acknowledge and represent that I have read it, understand it, and agree to these conditions voluntarily as my own free act and deed.