The undersigned head(s) of household agrees to participate in the Lakota YouthStay program by serving as a host for a Lakota youth. I understand that the Lakota YouthStay is a program of the West Medford Community Center which includes its director(s), officers, employees and the volunteer workers associated with the YouthStay program. I understand that there are certain risks of having people visit me and stay in my home, and I am willing to assume and bear any and all of these risks in order to meet and share experiences with a Native American youth from the Pine Ridge reservation in South Dakota. Therefore, in consideration of my selection by the Lakota YouthStay as a host for the exchange program, I do hereby release, indemnify and hold harmless the West Medford Community Center director(s), employees, officers, and volunteers from all claims, actions, and causes of action based upon or by reason of any loss, damage or injury to any person or property of any member of the household, arising out of, or in any manner connected with, any aspect of the YouthStay program.
As a host, I shall:
- agree to a home visit prior to acceptance as a host;
- agree to background checks for every adult (over 18 years of age) in the household prior to final acceptance as a host;
- agree to carry homeowners insurance which includes general liability coverage
- provide the same care, support and comfort for the Lakota youth as I would any member of my family for the specified days and nights; including but not limited to room, board, and local transportation (to and from airport and local program meeting sites).
- provide an opportunity for a Lakota youth to participate in daily lives and events of the members of my family;
- ensure the youth are available to participate in all group activities planned by the YouthStay program for the duration of the stay;
- commit to volunteer as a chaperone one full day during the YouthStay week;
- participate in all official functions that are planned for hosts during the exchange program;
- attend training workshops and an interview, if requested;
- attend host family orientation prior to arrival of Lakota youth;
- participate in post-trip survey to ensure continuous improvement of program;
- accept that the exchange is a public event and that the photographs and names of the hosts and host family members may be used by the local, regional, national and tribal media as well as West Medford Community Center in their publications;
- willingly accept in my home people who will be of another race, culture, and/or spiritual or religious preference and who have customs with which I may be unfamiliar.
I agree to be an ambassador of goodwill to the visitors I am hosting, knowing that the customs, habits and culture of those visitors may be different from my own. The purpose of this exchange is to build sustainable relationships with Native Americans and engage in an intercultural exchange.I agree to pay the Lakota YouthStay program an initial non-refundable application fee of $25 for the household. If my application is accepted upon review by the Program Director and/or Advisory Committee, I agree to pay the non-refundable application fee balance of $100 per adult household member* which covers the criminal/background check, home visit and other administrative costs associated with being a YouthStay host family.*
Adult members of the household over the age of 18. If the fees for background checks for all of your family members is a hardship, please contact the program director to discuss scholarship options for your household.