STUDENT APPLICANT LEGAL AGREEMENT

I understand that information I have provided in my application will be used to find the best
possible school placement and homestay for me. I agree that Black Gold School Division cannot
guarantee that all of my personal preferences will be met. I authorize Black Gold School Division to
release the information from my application to my school and homestay family.

I am aware that I must abide by all rules and regulations of Black Gold School Division, my host
family and the laws of Canada or I may be sent home at my own expense. I acknowledge that there
will be no refund of tuition nor homestay fees if I am sent home.

I agree to indemnify and hold harmless Black Gold School Division, their elected officials and
officers, employees, agents, volunteers and representatives, or any of them, from any claims,
demands, costs (excluding legal costs), suits, debts, liabilities and causes of action for which they
may become liable as a result of any personal injury or property damage that I, the parent of the
student cause or contribute, or are held responsible for, jointly or severally, in connection with the
student’s participation in study in Canada, including host family placement and from any financial
obligations the student may incur.

Furthermore, I certify that all information provided on and within this application is complete,
factually accurate and honestly represented. Should it be discovered that false information was
provided in my application, or true information was omitted from my application, I can be sent
home at my expense.

I further understand that the information furnished in my application, together with information
and materials of any kind pertaining to this student received by Black Gold School Division from
any source becomes the property of Black Gold School Division and cannot be returned.

Name of Student Applicant:

Signature of Student Applicant: Date:

Date:
Signature of Parent(s)/Guardian(s):