Musician Application
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Thank you for your interest in our Volunteer Music Program!
New User Details
User ID
User ID (verify)
Password
Password (verify)
Personal Information
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Name (preferred)
*
Last Name
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Cell Phone
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E-mail Address
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DOB
Are you at least 14 years of age?
Yes
No
Emergency Information
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Name of Emergency Contact
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Relationship
*
Mobile Phone
*
E-mail
Musical Experience
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Instrument(s)
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Years Studied
Please desribe any experience you have playing in hospitals:
Applying for a Position
Weekly
Special Event
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Who referred you to BIDMC?
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Link to Audio/Video Recording
Have you been excluded, suspended, debarred, or otherwise ineligible from working within any federal health care programs, state health care programs, or within federal procurement or non-procurement programs?
Yes
No
To the best of your knowledge, are you eligible to work within all federal health care programs, state health care programs, and federal procurement or non-procurement programs?
Yes
No
PLEASE READ CAREFULLY AND CLICK "I AGREE" BELOW
I certify that the information given above is true and complete and I understand that misrepresentation and/or withholding of information will result in the rejection of this application or my discharge if discovered after volunteer service begins. I authorize the Medical Center to make inquiries regarding my history and character of prior employers, schools, etc. and hereby release employers, schools or individuals from all liability in responding to inquiries in connection with my application and release the Medical Center from all liability with respect to such inquiries.
I understand that if I am a volunteer, I will be a volunteer "at will" and may terminate my volunteer assignment at any time with or without cause or notice and that the Medical Center also has that right. I also understand no representative of the Medical Center, other than the President, has any authority to enter into any agreement for volunteer service for any specified period of time or to make any agreement contrary to the foregoing and that such agreement must be in writing. As a volunteer, I agree to abide by the Medical Center's policies, rules and procedures and any changes thereto.
I understand that I must provide the Medical Center with updated immunization records that include verification of a Tuberculosis test within the past year. If under 18 years of age, please use the enclosed parental consent form.
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I agree