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Adult Registration
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* Indicates required question
Email
*
Your email
Please choose your registration type.
Adult Residential Registration — $900 through April 1 / $950 after April 1
Adult Commuter Registration — $625
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First Name
*
Your answer
Last Name
*
Your answer
Preferred Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address:
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
How long have you lived at the above address? *
*
Your answer
If less than 12 months, list previous address: *
*
Your answer
Cell Phone:
*
Your answer
Home Phone:
*
Your answer
Email:
*
Your answer
What is the best way to reach you
*
Email
Mail
Cell Phone
Home Phone
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?
*
Yes
No
Other:
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:
*
Choose
Alto
Tenor
Bass
T-shirt size (adult sizes, tend to run small)
*
Choose
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Adult XXXXL
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 Catholic University of America. Please email
rscmwashingtondc@gmail.com
for more information.)
Vegetarian
Vegan
Gluten Free
Dairy Free
None
Other:
Required
Insurance company
*
Your answer
Name on health insurance policy
*
Your answer
Policy Number:
*
Your answer
Primary Care physician name:
*
Your answer
Physician phone:
*
Your answer
Emergency contact name
*
Your answer
Emergency contact relationship to applicant:
*
Your answer
Emergency contact phone:
*
Your answer
Have you taken Safe Church Training (or a comparable program) provided by your church or diocese?
*
Yes
No
Where 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? *
*
Yes
No
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?
Yes
No
Clear selection
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
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