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SSIPARC

Proudly Supported by the CRD

SSIPARC

New Programs Application Form

Required fields are denoted with *

Contact Information:

Email*

Name*

Street Address*

City*

Home Phone*

Work Phone

Postal Code*

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 50 words or less try to sell us on this program)*

Day(s) of week*

Start Time*

End Time*

Start Date (Session #1)

End Date (Session #1)

# of Classes (Session #1)

Start Date (Session #2)

End Date (Session #2)

# of Classes (Session #2)

Start Date (Session #3)

End Date (Session #3)

# of Classes (Session #3)

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 (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? Specifiy:

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) 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
No

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Register Now

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PARC Main Office
262 Rainbow Road
Ganges, BC
V8K 2M3

Tel: 250.537.1402
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Territorial Acknowledgement

The CRD conducts its business within the traditional territories of many First Nations, including but not limited to BOḰEĆEN (Pauquachin), MÁLEXEȽ (Malahat), P’a:chi:da?aht (Pacheedaht), Pune’laxutth’ (Penelekut), Sc'ianew (Beecher Bay), Songhees, SȾÁUTW̱ (Tsawout), T’Sou-ke, W̱JOȽEȽP (Tsartlip), W̱SIKEM (Tseycum), and xʷsepsəm (Esquimalt), all of whom have a long-standing relationship with the land and waters from time immemorial that continues to this day.

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SSIPARC

SSIPARC

New Programs Application Form

Contact Information:

Qualifications & History:

Program Information:

Set-up Information

Program Budget

Important Note

Register Now

Contact Us

Useful Links

Territorial Acknowledgement

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