City of Blue Ash, OH - Program Proposal

Blue Ash Recreation Department - Program Proposal

Thank you for your interest in utilizing our facilities! In order to provide the best service possible to our patrons, we require all instructor-candidates to complete this proposal form. This form is for informational purposes only and does not imply a contract between the instructor and the City of Blue Ash. Your information will remain on file and will be reviewed periodically by a committee of individuals. In the event that there is a need for your program, you will be contacted to set up an interview with our staff. For more information on our current offerings, please visit www.blueash.com

1. INSTRUCTOR INFORMATION

Name: *

Street Address: *

City, State, Zip: *

Phone Number with Area Code: *

E-Mail Address: *

2. PROGRAM INFORMATION

Name of Class/Program: *

Objective: *

Age of Participants to be Served: *

Best TIMES to be held: *

Best DAYS to be held: *

Duration (i.e. twice a week for 6 weeks, etc.): *

Minimum Number of Participants: *

Maximum Number of Participants: *

Equipment that you possess:
*

Equipment that you would need provided to you:
*

Type of area is needed for class (pool, classroom, gymnasium, etc.):
*

3. DESCRIBE WHAT A PARTICIPANT WOULD EXPERIENCE IN A TYPICAL CLASS.

100 words or less:
*

4. WHAT FEES WOULD YOU CHARGE THE PARTICIPANT?

$2 per class, $40 for a 10-Punch pass, etc.: *

5. QUALIFICATIONS YOU POSSESS.

List certifications, experience, etc.:
*

6. DO YOU HAVE PROOF OF $1M LIABILITY INSURANCE COVERAGE?

Answer one:
Yes
No

7. PLEASE PROVIDE TWO REFERENCES THAT HAVE BEEN INVOLVED WITH YOUR CLASS, PREFERABLY A PREVIOUS COORDINATOR AND A PARTICIPANT.

Name: *

Title (if applicable): *

Street Address: *

City, State, Zip: *

Phone Number with Area Code: *

E-Mail Address: *

Name: *

Title (if applicable): *

Street Address: *

City, State, Zip: *

Phone Number with Area Code: *

E-mail Address: *

Thank you for your submission. Our decisions are determined by a committee of individuals so your program may or may not be selected. PLEASE BE SURE YOUR INFORMATION IS ACCURATE. After you submit this application, you will not be able to edit, change or update your application. Thanks and good luck!