New Program Application Form

First Name

Last Name

Address

City/Town

Province

Postal Code

Home Phone

Work Phone

Qualifications & History:

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

Briefly describe the history of your organization and/or program. If this is a first time program, briefly tell us why you feel you are a qualified instructor. Also include 2 references in the space below.

Reference #1 Name:

Reference #1 Phone:

Reference #2 Name:

Reference #2 Phone:

If you have your own GST# and/or WCB# please include in the space below:

GST#:

WCB#:

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 Title

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

Day(s) of week

Start Time

End Time

Course Information

Course Information
	Start Date End Date # of Classes	Item weight

more items

Please note that programs typically do not take place on Stat Holidays. Please indicate which session does not have a class if it falls on a Stat holiday.

Minimum participant age:

Maximum participant age (if applicable)

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).

Program Budget

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:

Please confirm the wage/percent of revenue you would like to receive.

Comments/ Special Instructions

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