Part-Time Hourly Application Form

Parks & Rec Programs Request Form

This form is for outside groups interested in hosting a program at a park, greenway, and / or recreation or community center.
Note: Type NA if it doesn't apply
TYPE OF REQUEST
CONTACT INFORMATION
Applicant Name
Phone
Email
Business Name
Website
Social media handles
Street address
City, State, Zip
PROGRAM INFORMATION
Name of Program / Activity / Specialty proposed
Name of Program Leader / Facilitator
Phone Number of Program Leader / Facilitator
Email of Program Leader / Facilitator
Requested program start season (Check all that apply)
Estimated total duration of program (Indoor sessions are usually 8-week sessions. Scheduling is based on facility and staff availability.)

Other
Requested day(s) (List in order of preference)
Requested time(s) (start time & end time) (list in order of preference)
Where will your program be held?
If outdoors, type preferred location(s) (List in order of preference, info located at KnoxvilleTN.gov/Parks)
If indoors, type preferred location(s) (List in order of preference, info located at KnoxvilleTN.gov/RecPrograms. Please note that scheduling is based on facility and staff availability)
Brief description of program
Anticipated attendance per session
Will this program be open to the public (meaning that anyone can join/participate)?
Will there be a fee to participate in the program?
If Yes, what is the fee to participate?
Non-Discrimination Policy

Partner Organizations

(A)       will not discriminate against any employee or applicant for employment because of race, age, color, religion, national origin, sex or disability;

(B)        will take affirmative action to insure that applicants are employed, and that employees are treated during employment, without regard to their race, age, color, religion, national origin, sex or disability; and

(C)       will, in all solicitations or advertisements for employees placed by or on behalf of it, state that all qualified applicants will receive consideration for employment without regard to race, age, color, religion, national origin, sex or disability.

(D)       will include these provisions in every subcontract or sublease let by or for it.

The requirements of above shall not be construed to limit any employment action the Organization is authorized to take pursuant to federal law.

Reasonable Accommodations for participants with a disability

Partner organizations shall not discriminate on the basis of disability and must provide reasonable modifications for participants with disabilities. The Organization should consult with KPRD staff to discuss and determine reasonable accommodations.
I have read, understand, and agree to follow the Non-Discrimination Policy.
Signature
NEXT STEPS
Please email the following or upload in space below to abrowning@knoxvilletn.gov or upload in the space below

• Current Certifications (such as NCCA, ISMA, AAA-I)
• Current First Aid/CPR Certification
• Liability Waiver that will be used
• Certificate of Insurance listing the City of Knoxville, 400 Main St, Knoxville TN 37902 as additionally insured for a minimum of $1,000,000 per occurrence and $2,000,000 aggregate and the Waiver of Subrogation endorsement
File Upload (can also be emailed)

Cancelof
Knoxville Parks & Recreation will be in touch following your submission.
Failure to complete this form in its entirety could delay review and approval process.
Please allow up to 2 weeks for processing once all documents are submitted. Program start date may vary based on facility / park / staff availability.
Should be Empty:

Parks & Rec Programs Request Form

TYPE OF REQUEST

CONTACT INFORMATION

PROGRAM INFORMATION

NEXT STEPS