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2. Thank you for your interest in becoming a CPP with the Fishers Parks and Recreation Department.
   Please fill out the following form with your class information, and submit it once you have completed fields. If you have any questions, please contact the Parks Department at 317-595-3150.
4. Full Name*
5. Date*
   Date
7. Address*
9. City*
10. Zip
11. I Am 18 Years or Older

    1. Yes
    2. No
13. Primary Phone Number*
14. Secondary Phone Number*
16. Email*
17. Fax Number*
19. Do you represent a group / organization?

    1. Yes
    2. No
21. Age Group Interest*
23. Some types of classes require outside insurance. Can you provide proof of insurance?*

    1. Yes
    2. No
25. Please Upload a Copy of Your Insurance
27. What type of program / class do you want to offer? Please include cost for participants, facility needs, days / times, and description of class.*
29. Additional Proposals or Past Marketing Material May Also Be Uploaded
30. Additional Proposals or Past Marketing Material May Also Be Uploaded
32. Please Upload Any Relevant Instructor Certificates
33. Professional References*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field