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Burlington Parks and Recreation Department – 900 E. Fairhaven Avenue Burlington WA 98233 – Ph: [PHONE REDACTED] – [EMAIL REDACTED] Instructor Packet rev. 09-2018 900 East Fairhaven Avenue Burlington, WA 98233 Phone (360) 755-9649 Fax (360) 755-1017 [EMAIL REDACTED] NEW INSTRUCTOR INFORMATION FORM Thank you for your interest in presenting a class through Burlington Parks and Recreation Department. In order to help you put your proposal into a format that we can more easily work with, we ask that you fill out the following questionnaire. If you have copies of your artwork (if proposing a craft class or copies of a handout you may have put together, please attach it). Other factors which will be considered are: Is this class currently being offered in this community? If so, is the demand for this class more than is available or would the addition of another class be in competition with other programs, or is the demand higher than what is being currently provided? Is this class consistent with the mission of the Burlington Parks and Recreation Dept? Would this class be more appropriately offered by another agency or by a private business? Is the targeted audience being adequately served by our agency? Does the class seem well thought out and realistic in both goals and scope? Once you have completed the questionnaire, you may drop it by our office or mail it back to: Burlington Parks & Recreation Department Attn: Christi Kinney 900 East Fairhaven Avenue Burlington, WA 98233 or email: [EMAIL REDACTED] We will contact you if we have interest in pursuing your class proposal. Please keep in mind that we are always planning programs well in advance of class dates and any proposals that are not considered feasible at the current time will be kept for consideration at a future date. We would like to thank you for taking the time to share your ideas with us! ---PAGE BREAK--- Burlington Parks and Recreation Department – 900 E. Fairhaven Avenue Burlington WA 98233 – Ph: [PHONE REDACTED] – [EMAIL REDACTED] Instructor Packet rev. 09-2018 CLASS PROPOSAL QUESTIONNAIRE Your Phone: Address: Zip: E-mail Address: CLASS INFORMATION: What type of class do you want to offer? (Check one) ___Craft/Hobby Instruction ___Art ___Dance ___Trip or Tour ___Lecture/Informational ___Outdoor Name of class you would like to teach: Class Description: Ages of Class # of Participants: Max Class Start Time: End Time: Days of the Session Dates: Begin # of Weeks Anticipated Cost for Participants:_________________ Please indicate the age group(s) your class is designed for: ___Preschool ___Youth (Ages 6-12) ___Teens (Ages 13-17) ___Adults ___Families ___Special Populations What are your goals for your participants? What specific skills will participants ---PAGE BREAK--- Burlington Parks and Recreation Department – 900 E. Fairhaven Avenue Burlington WA 98233 – Ph: [PHONE REDACTED] – [EMAIL REDACTED] Instructor Packet rev. 09-2018 Are there any material costs involved in offering this class? Materials Cost Materials Cost 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. TOTAL COST: Do you need: Indoor Facility Outdoor Facility Other Explain Needs: Describe your background and expertise level relating to the class you would like to teach: Please list you references that could tell us more about your abilities as an instructor? NAME DAY PHONE RELATIONSHIP TO YOU 1. 2. 3. 4. Do you have any other skills or talents that you would like to share with the community through a Parks and Recreation Class? ---PAGE BREAK--- Burlington Parks and Recreation Department – 900 E. Fairhaven Avenue Burlington WA 98233 – Ph: [PHONE REDACTED] – [EMAIL REDACTED] Instructor Packet rev. 09-2018 CONTRACTED INSTRUCTOR CHECK LIST RECREATION PROGRAMS Contracted Instructor Requirements: Background Check Signed City of Burlington Professional Services Agreement (contract) Completed W-9 Form Additional Requirements as determined by the city. Copies of License or Certificate of Accreditation Liability Insurance: Instructor must provide a Certificate of Insurance to the City with endorsement which meets the following minimum requirements: 1. The City of Burlington at 833 S. Spruce Street, Burlington WA 98233 must be named as an “Additional Insured” on the certificate. 2. The certificate MUST contain the statement “Additional Insureds include the City of Burlington, its Elected Officials, Appointed Officers, Employees, Volunteers and Agents”. 3. The liability insurance must provide a minimum threshold of $1,000,000 per occurrence with $2,000,000 General Aggregate coverage. City staff to inspect the facility to be utilized if not held at a City Facility. NOTES or COMMENTS: