* indicates a required field

2. Recreation Program Proposal

4. The City of East Chicago Park and Recreation Department partners with groups, businesses and individual instructors for youth and adult leisure enrichment, fitness, sports and adapted activities.  Please complete the following information.

6. Instructor's Name*
8. Address*
9. City*
11. State*
12. Zip Code*
13. Phone Number*
15. Email Address*
17. Program/Class/Camp Name*
19. Description of proposed class, program and or activity:*
21. Class/ Camp Size (Number of Participants)*

    Minimum

22. Class/ Camp Size (Number of Participants)*

    Maximum

24. Gender Preference*
25. Age Group Range*
27. Space Requirements (i.e. AV, tables,seating, etc. )*
31. Preferred day(s)*
32. Preferred time(s)*
34. Class/ Camp/ Program session length ( i.e, 6 weeks)*
36. Multiple Sessions*

    1. Yes

    1. No
38. If you answered yes, please give a brief description.
40. ADDITIONAL INFORMATION: Please include any past work experience in this field.*
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

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