Adult Chorister/Choir Director Application
Email address *
First Name *
Your answer
Last Name *
Your answer
Preferred Name *
Your answer
Date of Birth *
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DD
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YYYY
Address: *
Your answer
City *
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State *
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Zip *
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How long have you lived at the above address? * *
Your answer
If less than 12 months, list previous address: * *
Your answer
Cell Phone: *
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Home Phone: *
Your answer
Email: *
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What is the best way to reach you *
Current Employer *
Your answer
How long have you been employed there? *
Your answer
Church/School Name: *
Your answer
Church/School Address *
Your answer
Are you the choir director of your church/school? *
If no, please list choir director's name:
Your answer
Choir Director's phone *
Your answer
Choir Director's email *
Your answer
Priest/Pastor's Name *
Your answer
Priest/Pastor's Email *
Your answer
Voice Part: *
T-shirt size (adult sizes, tend to run small) *
Do you have any medical conditions that we should be aware of should there be a medical emergency (i.e. seizures, fainting, asthma, etc.)? If so, please explain here: *
Your answer
Please list any special dietary needs or allergies below: *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Required
Insurance company *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Name on health insurance policy *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Policy Number: *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Primary Care physician name: *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Physician phone: *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Emergency contact name *
(N.B. Most special meal needs can be accommodated by Marymount University. Please email rscmwashingtondc@gmail.com for more information.)
Your answer
Emergency contact relationship to applicant: *
Your answer
Emergency contact phone: *
Your answer
Have you taken the Safe Church/Sexual Ethics Training provided by your diocese? *
Where did you complete your training?
Your answer
What year did you complete your training?
Your answer
What year did you complete your training?
Your answer
Have you ever been convicted of a criminal offense? * *
Required
If yes, please explain.
Your answer
Have you ever been found by a civil court to have caused significant harm to a child or young person under the age of 18, or has any civil court made any finding against you that any child or young person under the age of 18 was at risk of significant harm?
If yes, please explain.
Your answer
I declare that all the information I have provided is true and complete to the best of my knowledge. I acknowledge that an affirmative response below constitutes my signature.
Your answer
Please provide the name & contact information of two people (one clergy & one lay) who have known you at least two years and who will provide a personal reference. You will find the link to the reference form on the website's Registration page. Please share this link with your references. *
Your answer
Are you or your church a member of RSCM America? *
How will you be paying the deposit for this registration? * *
A copy of your responses will be emailed to the address you provided.
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