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2. Class Name:*
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. # of classes per week*
    -- Select One --Once per weekTwice a weekMeets every other weekOther
17. Class Schedule*
    Class Schedule Start Date

    —

    Class Schedule End Date

    This is a tentative class schedule for your first session. 

19. # of classes per session

    Add up the total number of meeting dates for your first session. 

20. Resident Price

    This is the amount participants will be paying for the entire session. (ex: a class that meets twice a week for 6 weeks = $85).

21. Non-Resident Price

    We require all classes to set a Non-resident rate that must be at least $5.00 more than the Resident rate. 

23. Meeting Date*
    -- Select One --Monday TuesdayWednesdayThursdayFridaySaturday/Sunday
24. Additional Meeting Date
    -- Select One --MondayTuesdayWednesdayThursdayFridaySaturday/Sunday

    Please select a different meeting date in the event your first choice is not available. 

25. Class Time*
    Class Time Start Time

    —

    Class Time End Time
27. Age Range

    Please provide the age range of participants for this class. 

28. Background Check Requirement*

    1. Yes

    By clicking the box above, I acknowledge that I will be responsible for completing a criminal background check for myself and all coaches, sub-contractors, volunteers, etc. associated with my program. 

30. Equipment Used:

    The City of Laurel Department of Parks & Recreation does not provide equipment or equipment storage. 

31. Facility Request
    -- Select One --gymnasiumdance room multipurpose roomoutdoor field spaceother

    Please provide the facility location and space requested for your program.

33. Class Description:

    Please provide a detailed description of your class. Your description should provide a clear overview of your class that can later be used for advertising online and in our seasonal brochure. 

35. Instructor Certification(s)
36. -- Select One --
Leave This Blank:


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

    This field is not part of the form submission.

40. Submit

* indicates a required field