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2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Primary Phone Number*
12. Secondary Phone Number
14. Class Type*
    -- Select One --Adult ProgrammingArtCheerleadingDanceEducationExerciseMartial ArtsMusicOutdoorSpecial IntersestSportsOther

    Please select one.
15. Other:
17. Class Name*
19. Maximum Number of Students*
20. Minimum Number of Students*
21. Age Range*
23. Time*
    What time would you like to hold the class? You may list multiple time frames.
24. Day(s)*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday

    What day of the week would you like to hold the class? You may choose multiple days.

25. Number of Sessions*
    How many consecutive weeks would you like to hold the class?
26. Specific Dates *

    List the date(s) or date ranges for your class(s). 

28. No Class Dates*

    Are there any dates you are not able to host class due to personal reasons/holidays/vacations? If so, list them here.

    Please note, the Recreation Center will be closed on federal holidays.

29. Class Fee*

    How much would you like to charge for the class? Please note that you will retain 70% of all fees collected.

30. Equipment/Attire*
    What are students expected to wear/bring to class?
31. Pre-Requisite *
    Are there any skills or classes a student must have prior to taking this course?
33. Class Description*

    How would you like your course description to read? This class description will be published online and in our PlayTC catalog.

35. About You*
    Please provide a short biography (75-100 words).
37. Qualifications*
    Please list your qualifications and experiences with this subject matter.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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