New Programs Application Form

First Name

Last Name

Business Name (If applicable)

Address

City/Town

Province

Postal Code

Phone

Program Information:

Submit a separate form for each unique program ie. if you teach Yoga and Pilates, or if you teach the same program on different days and times each week.

Program Category

Program Title

Program description for the brochure (in 550 characters or less try to sell us on this program)

Day(s) of week

Course Information

Course Information
	Start Date End Date Total Sessions Start Time End Time Any exclusion dates due to stat holidays? Please note:	Item weight

more items

Minimum participant age:

Maximum participant age (if applicable)

Suggested participant registration fee

Does the program require us to charge an additional fee for supplies or training manual? Specify:

Minimum # of registrants to offer program:

Maximum # of registrants:

Panorama Recreation Centre staff are typically permitted 50% off registration fees for registered courses. Recognizing that Staff registrants will reduce revenue, please indicate your willingness to participate:

Please confirm the revenue split negotiated with your Program Coordinator.

80%

70%

60%

Other

Set-up Information

How much set-up and take down time do you require prior to your class?

Please list additional equipment and/or set-up needs requested from us (e.g. TV/VCR, DVD, Flip Chart, Table/chairs).

Comments/ Special Instructions

Qualifications & History:

Briefly describe the history of your organization and/or program. Tell us why you feel you are a qualified instructor.

List all relevant qualifications and certifications useful for instructing your program:

Reference #1 Name:

Reference #1 Relationship:

Reference #1 Phone #

Reference #2 Name:

Reference #2 Relationship:

Reference #2 Phone #

Please provide a brief bio of you and/or your organization that can be made visible to program registrants upon registration.

Important Note

All contractors and their employees are required to provide proof of a recent (within 1 year) municipal Criminal Record Check prior to the start of the program. Criminal Record Checks can be obtained from your local Police Department.

I understand that this is required:

Yes

New Programs Application Form

Program Information:

Set-up Information

Qualifications & History:

Important Note

Feedback details

Territorial Acknowledgement