Form Center

2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
15. Class Title*
16. Minimum Number of Participants
18. Class Description
19. Maximum Number of Participants
21. Participants

    1. Adult Women
    2. Adult Men
    3. Adult - all genders
    4. Senior Women (over 55)
    5. Senior Men (over 55)
    6. Seniors - all genders
    7. Youth ages 3-5
    8. Youth ages 6-11
    9. Youth ages 12-16
    10. Youth ages 17-21
22. Day(s) of the week

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
23. Facility

    1. ARTcabin (wood floors, sink, windows)
    2. UPCC North Room (vinyl floors, no windows)
    3. Parks & Recreation Classroom (rubber floor, no sink, no windows)
    4. UPCC Community Room (carpet, no sink, windows)
    5. Aquatic Center Party Room (concrete floors, sink, bathrooms, windows)
    6. Other
25. Class Date & Start Time
    Class Date & Start Time

    Class Date & Start Time
26. Class Date & End Time
    Class Date & End Time

    Class Date & End Time
28. Use this field if you have many dates and times to enter
30. Cost

    P & R will retain 30% of this fee for ARTcabin programs, 25%-minus facility fees for P&R Classroom programs

31. Supply List

    These are items that the participant must bring to class.

32. Supply Fee

    Payable directly to instructor at first class

34. Marketing Photo

    Please upload a photo that we may use to market your class. If you do not have one, we will use a stock image with your approval.

36. Electronic Signature Agreement

    It is my understanding that should the Department of Parks and Recreation accept this proposal, a contract for services will be prepared for my signature. It is further understood that the program/activity details may be changed by mutual agreement of both parties and that formal approval to establish fees and initiate the activity can only be provided by the Parks and Recreation Department in accordance with the established policies.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
38. Electronic Signature
39. Date
    Date

    Date
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field