Program Proposal

Program Proposal

for Hernando Parks & Recreation
Contact Information
Name

First NameLast Name
Company/Organization Name (if applicable)
Address
Primary Phone Number
Please enter a valid phone number.
Email
Website (if applicable)
Program Overview
Program Name
Type of Program

Art/DanceAthleticsEducation & EnrichmentEnvironmentalFitness & HealthLeisure & SocialOther
If your program proposal does not fit in one of the above categories, please explain.
Intended Audience - Age (Please check all that apply)

Preschool (Ages 3-5)Youth (Ages 5-11)Pre-teens (Ages 11-13)Teens (Ages 13-18)Adults (Ages 18 and up)Seniors (Ages 55 and up)All AgesOther
Intended Audience - Gender

MaleFemaleBoth
Preferred location for your proposed program

Gale Community CenterChurch ParkConger ParkKuykendall ParkLee's Summit ParkRenasant ParkParkway Cove ParkAddie Baldwyn Park (basketball court)Other
Description of program
Please write a description of the program you would like to offer and include details such as skills/techniques being taught, any curriculum information, staff ratios, tools, supplies, etc.
Goals of Program
Please include how the residents of Hernando will benefit from this program.
Program Details

Proposed program details are subject to change.
Program Start Date
Program End Date
Program Start Time
Program End Time
Number of Weeks
Days of the Week

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
Minimum # of Participants
Maximum # of Participants
Proposed Program Fee
Instructors must sign a contract with the city and will receive a percentage of the registration fees.
Equipment & Supplies
What equipment and/or supplies will be provided by the instructor?
What equipment and/or supplies will the Hernando Parks Department need to provide for this program?
What will participants be required to bring?
List any special site or set-up requirements that would need to be addressed prior to the program?
Instructor Qualifications
List any experience and/or qualifications to teach this program.
Are you certified in any of the following:

First AidCPRAED
Other than the city's marketing initiatives, how do you plan to advertise? Do you currently have any participants or prospects?
Disclaimer and Signature
All approved programs will require the instructor to undergo a background check, facilitated by the City of Hernando.

The instructor will not be considered a regular employee of the City of Hernando and will not be entitled to any benefits afforded to regular wage employees including (but not limited to) insurance, sick leave, vacation leave, workers compensation or any other employee benefits given to regular wage employees of the City of Hernando and I accept this responsibility.

Registration will be handled by the City of Hernando's Parks Department and all fees will be paid to the department by participants. Submission of this form does not guarantee approval of the course, location or dates/times. There is no exclusivity to instructors or the programs they teach. If providing instruction or service for compensation, an agreement/contract is required prior to providing instruction or service. The City of Hernando will issue payment to instructors after the completion of services and the approval of the check request by the Hernando Board of Aldermen

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Today's Date
Signature
Attachment

Please include any attachments that would help us better understand your program proposal. (Not required)
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Should be Empty:

Program Proposal

Contact Information

Program Overview

Program Details

Equipment & Supplies

Instructor Qualifications

Disclaimer and Signature