House Substitute Application

House Substitute Application

We are honored that you have considered Substituting with House!
DISCLOSURE: Compensation is offered through the instructor in need of Substitution- arrangements will be made directly with the teacher and the Substitute available.

A successful Background Check must be submitted, processed, and received by our Executive Team.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number:*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MONDAYS - Confirm Availability (if multiple, please indicate)

9:30am - 12:30pm (3 Hour Block)1:15pm - 4:30pm (3 Hour Block)1:30pm - 2:30pm (1 Hour Block)2:30pm - 3:30pm (1 Hour Block)3:30pm - 4:30pm (1 Hour Block)4:30pm - 5:30pm (1 Hour Block)
TUESDAYS - Confirm Times Available

5:00pm- 8:00pm (3 Hour Block)
Please Acknowledge The Following
House Theatre Inc, Code of Conduct
Please Check The Following

I have read, understood, and agree to demonstrate respect towards House Theatre's Code of Conduct and Statement of Faith.
Medical Waiver

Applicants must complete a medical waiver to participate in House.
Emergency Contact Name 1*

First NameLast Name
Relation to Participant*
Phone Number*

Area CodePhone Number
Emergency Contact Name 2*

First NameLast Name
Relation to Participant*
Phone Number*

Area CodePhone Number
Insurance Card Information
Please indicate any medical history deemed necessary. Note that the attached waiver is provided for transparency and clarification.
Are there any allergies we should be made aware of? Please indicate the level of sensitivity if deemed necessary.
Date of Form Completion

MonthDayYear
Date
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
Should be Empty:

House Substitute Application

House Theatre Inc, Code of Conduct

Medical Waiver