Recreation Class Proposal FormCIIS ok,ane
'd ; o 0owley.
Instructor:
Address:
City:
SUMTUWTHFSA
Proposed End Date:
To AM /PM
Phone #'s: Day: Evening:
X11". FIX re M-M
Information listed below represents a proposal I am submitting for consideration by the
City of Spokane Valley Parks and Recreation Department.
Class /Program Title:
Brief Program Description: (Recommended brochure copy)
(Enclose a photo if available)
General Class Information
First Choice
Day(s) of week would like to offer class:
Proposed Start Date:
Time: From AM /PM
Second Choice
Day(s) of week would like to offer class: SU M TU W TH F
Proposed Start Date: Proposed End Date:_
Time: From AM /PM To
Zip:
SA
AM /PM
Please circle the seasons the program could be offered:
WINTER SPRING SUMMER FALL
(Jan. — Mar.) (Apr. — June) (June — Aug.) (Sept. — Dec.)
Age Group: From to Years
Target Gender: (Please circle one) Male Female Co -ed
Minimum Number of Students: Maximum Number of Students:
Proposed Fee Charged for the Class: $
City of Spokane Valley Parks & Recreation Department
Class Proposal Form
P: \Parks & Recreation \Recreation \Forms \Instructor Forms \Class Proposal
Form s \FRM_ClassProposal.doc
Supplies /Equipment:
Facility /Room Requirements:
Any additional supplies students need to purchase above the class cost?
If yes, please indicate the amount: $
Does Instructor purchase for the student? Yes No
Equipment /Supplies Instructor provides-
Equipment/Supplies Recreation Department provides:
Instructor Information:
1. Do you have general liability insurance for your business? If yes please include a copy of that
insurance when returning this form.
If NO — The City must take you on as an employee vs. a contract instructor.
Please indicate your answer by circling one: Yes No
2. Do you have CPR or First Aid Certifications? If so, please list dates of certification.
CPR
First Aid:
3. Have you taught this class before? Yes No
If yes, where?
Please explain the experience you have teaching this class or cross training experience that
enables you the ability to teach the proposed class:
Please list (3) references that we may contact: (Name and Phone Number)
Complete and return the attached Authorization to check Background and Driving Record.
Please return to:
City of Spokane Valley Parks and Recreation Department
Attn: Jennifer Papich
2426 N. Discovery Place
Spokane Valley, WA 99216
Fax: 509 - 688 -0188
Yes No
P: \Parks & Recreation \Recreation \Forms \Instructor Forms \Class Proposal
Form s \FRM_ClassProposal.doc