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2. Instructor Information
4. First and Last Name*
5. Company *If Applicable
7. Address*
8. City*
10. State*
11. Zip*
12. Phone number*
14. Email*
15. Website
17. Facebook
18. Instagram
19. Twitter
23. Do you have general liability insurance?*

    1. Yes
    2. No
    3. I am interested in purchasing general liability insurance through the City of Malibu
24. If yes, do you have coverage for $2,000,000 aggregate?

    1. Yes
    2. No
25. Insurance Agent
27. Program Information
29. Title of Proposed Program*
31. Program Description*
33. Is the program meant to be a one-day workshop or weekly program?*

    1. One-day Workshop
    2. Weekly Program
    3. Both
34. Program Category*
    -- Select One --Parent & MeYouth/TeenAdultSeniors (55+)SportsAquaticsCreative Workshop
36. If a weekly program, will it be a 6, 8, 10 or 12 week session?
38. Minimum number of participants:*
39. Maximum number of participants. An assistant is required for programs with more than 15 participants.*
41. Desired Start Date
42. Preferred Day of the Week
44. Preferred Start Time
45. Duration of Program
47. Which session are you interested in teaching?*

    Select all that apply.

    1. Winter (January - March)
    2. Spring (April - Mid June)
    3. Summer (Mid June - August)
    4. Fall (September - December)
48. Does the program take place indoor or outdoor?*

    1. Indoor
    2. Outdoor
    3. Flexible on Indoor/Outdoor
50. Preferred Program Fee (The City of Malibu provides 70% of the fee to the instructor). *
51. Daily/Drop-In Fee*
53. Supplies/equipment instructor will provide:*
55. Supplies/equipment/attire that the participants will need to provide:*
59. Professional References
61. Professional Reference 1 (Name and Title)*
62. E-Mail
64. Professional Reference 2 (Name and Title)*
65. E-Mail
67. Professional Reference 3 (Name and Title)*
68. E-Mail
70. Forms
72. Email completed forms to Adrianna Fiori at afiori@maibucity.org
74. Background Check
    National Background Screening Consent and Release Form
75. Contract Instructor Agreement
    Form
76. W-9
    W-9 Form
78. 1. Application must address logistics as requested (i.e. description, dates, time, deadline, etc.). Proposals and attachments may not be submitted in lieu of the “Intent to Instruct” application. 2. Submitting this application is not confirmation your class has been approved. 3. Classes will not be held on observed holidays. 4. No additional classes other than what is advertised in the City’s Recreation Guide will be permitted without City authorization. 5. Classes that are cancelled due to low, or no, enrollment for two consecutive sessions may no longer be offered. 6. The City handles all registration for classes. Instructors are not permitted to collect fees under any circumstances. 7. It is required that all instructors, subcontractors, volunteers and assistants participate in a fingerprinting and background check. 8. Instructors are required to obtain written authorization from the City prior to assigning subcontractors. Subcontractors will be required to complete an Independent Contract Agreement and provide the City with an outline of their qualifications along with providing three (3) professional references. 9. Independent contract instructors will not discriminate against any employee, volunteer, participant or student due to race, religion, creed, color, national origin, gender, sexual orientation, physical or mental handicap, marital status, veteran status or age. 10. The City works on a 30/70% split (30% of gross receipts goes to the City, 70% goes to the instructor).
80. Signature*
81. Date *
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field