EmailMe Form - Program Proposal Form

Name

First Last

Business Name (If Applicable)

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Email

Phone

### - ### - ####

Program Name

Age Groups (Can Click Multiple)

Children

Teens

Adults

Specific Age of Participants

Program Description

Be specific and complete. Is this a one-time program or will participants participate season after season? Is this program a building block for participation in other future programs? Is there a community benefit to this program?

How Can This Program Be Adapted For Individuals With Disabilities?

Participant Outcomes

Be specific AND measurable. What will the participants get out of this program?

Date/Day(s) of The Week

Times (Start and End)

Duration (Number of Weeks)

Min Class Size

Max Class Size

Season

Fall (September-December)

Winter (January-March)

Spring (April-May)

Summer (June-August)

Must be proposed the season prior to the intended program season.

Required Equipment

Distinguish between equipment YOU can provide, equipment you need ELP&R to provide, and equipment that participants must bring.

Proposed Rate of Pay

Suggested Participant Fee

Our programs are self-funded, which means we can only run programs that we can afford to run. ELP&R can assist in current market price conditions. ELP&R reserves the right to refrain from offering a program that is deemed incorrectly priced.

Business Information

I own my own business that provides this service

I provide similar services to other agencies

I can provide a certificate of insurance

East Lyme Parks and Recreation hires both employees and independent contractors to lead programs. Based on the number of boxes checked, the Town of East Lyme will make a final determination which method will be used.

Thank you for your time and consideration. This proposal form will be reviewed by the Program Coordinator, who will reach out to you after review.
Thanks!