Section 1 of 1 in this document

City of Maple Valley Parks & Recreation New Class Proposal Form

Instructor Name

Organization

Address

City

Zip Code

Preferred Phone Number

Alternate Phone Number

The information listed below represents a proposal I am submitting for consideration by the City of Maple Valley Parks & Recreation Department.

Program Description

General Program Information

Will your class take place in the daytime or evening hours?

1st Choice - Preferred Class Day(s)

Sat

2nd Choice - Preferred Class Day(s)

Sat

Which seasons will this program be offered? Select all that apply.

WINTER (January-April)

SPRING/SUMMER (May-August)

FALL (September-December)

Describe the ages this program would be offered for

Minimum # of participants

Maximum # of participants

Proposed fee for class

Supplies & Equipment

Facility Requirements

Equipment/supplies provided in the instructor

Equipment/supplies provided in the Recreation Department

Instructor Payment Information

How instructor would like to be paid for services rendered. Please choose one option.

Percentage split of 70% to instructor/30% to the City

Volunteer time/no payment requested

Do you have current CPR & First Aid Certification?

Yes

If yes, list date(s) of certifications

Do you currently possess Commercial Liability Insurance?

Yes

Have you taught this class before?

Yes

If yes, when and where?

Please explain the experience you have teaching this class or cross training experience that enables you the ability to teach the proposed class.

Is there anything else about the program or details you'd like to share?

Please List 2 Professional References Below:

Name

Organization

Phone Number

Name

Organization

Phone Number

Upload any file(s) you'd like. This is not required.

Click Here to Upload

Instructor Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.