Indiana University Bloomington
* Visit confirmations will be sent via email. Please make sure the address provided is correct and checked often.
You are not guaranteed the date for this visit until you receive final confirmation.
Please note: While we try and accommodate you with students of the same major and academic interests, we cannot guarantee an exact match.
Please list up to three personal interests you’d like to learn about during your visit (i.e. intended major, specific student clubs, particular academic programs, facilities, etc.).
This section must be completed in order to submit the HOST Visit Request Form.
Student Consent & Release:
In consideration of the opportunity provided to me by Indiana University’s Office of Admissions, to participate in the HOST Program, I hereby agree that: I understand that by participating in the Office of Admission's HOST Program, I will be provided the opportunity to accompany an assigned IU student through their normal routine on campus for the day. By accompanying an IU student throughout their day on campus, I understand that I may be provided the opportunity to observe and possibly participate in activities such as academic classes, lessons, labs, study groups, meals, sports activities, social functions and other academic and social activities that may be occurring on and around campus. I understand that as a guest on campus I am expected and obligated to act responsibly and abide by the rules and regulations of Indiana University, which are designed to build a friendly, caring and safe atmosphere. I will review the IU Code of Student Rights, Responsibilities and Conduct for further information about these rules before my visit.
I understand that certain risks may be inherent to my participation in the HOST Program and in traveling and interacting with others in, on, and around campus, and I fully accept those risks. Such risks may include, but are not limited to, such things as accidents and incidents related to walking, vehicular travel, adverse weather conditions, criminal activity, loss, damage or theft of personal property, food allergies, and other physical, mental and emotional injury including the risk of catastrophic injury or death.
I fully understand the risks and scope of the activities I may be involved in by my participation in the HOST Program, as described above and elsewhere on this site, and by being present in, on and around the Indiana University campus, and I agree to assume the risks of my participation in the HOST Program.
I understand that my participation in the HOST Program is entirely voluntary and at my own risk. I understand and agree that Indiana University does not provide insurance to cover medical expenses for injuries that may be sustained by me or for damage to my personal property.
I release and fully discharge The Trustees of Indiana University, and its employees, officers, and agents, from all liability in connection with my participation in the HOST Program, for or on account of any injury to or illness of my person or death, or for or on account of any loss or damage to any personal property or effects owned by me.
Notwithstanding any other agreement that I have signed related to my participation in the HOST Program that purports to establish the venue for any litigation arising from my participation, I agree that I will file no action against The Trustees of Indiana University, or its officers, employees and agents whether based on this waiver or in any way otherwise connected to this Trip in any court other than the Circuit Court of Monroe County, Indiana.
Parent/Legal Guardian Consent & Release:
I have carefully read the statements above pertaining to my child’s participation in the HOST Program and I fully understand and agree to the statements contained therein. I hereby certify that I am the parent and/or legal guardian of the participant listed above. I hereby give permission for my child to participate in the HOST Program subject to the terms of this Consent, Assumption of Risk and Release of Liability, including but not limited to, my release and full discharge of the Trustees of Indiana University, and its employees, officers, and agents, from all liability in connection with my child’s participation in the HOST Program, for or on account of any injury to or illness of my child’s person or death, or for or on account of any loss or damage to any personal property or effects owned by me or my child. In addition, I hereby consent/authorize the provision of emergency care for my child (in the event that I cannot be reached). This includes authorization for emergency medical treatment from any reasonable, accessible health care institution should the need arise. I understand that I will be notified as soon as possible of any emergency situation. Further, I understand that I (or my insurance provider) will be responsible for all medical costs related to the emergency.
For confirmation purposes, please enter the characters you see in the image below.
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