Form Center

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
20. Do you have general liability insurance?*

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

    1. Yes
    2. No
26. Program Information
28. Title of Proposed Program*
30. Program Description*
32. Is the program designed to be a one-day workshop or weekly program?*

    1. One-Day Workshop
    2. Weekly Program
34. Program Ages Category*
    -- Select One --Parent & Me (Ages 5 and Under)Youth (Ages 6-12)Teen (Ages 13-17)Adult (Ages 18-54)Seniors (Ages 55+)
36. Minimum number of participants:*
37. Maximum number of participants. An assistant is required for programs with more than 15 participants.*
39. Preferred Day of Week

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
40. Preferred Time of Day

    1. Morning
    2. Afternoon
    3. Evening
42. Which season are you interested in instructing?*

    Select all that apply.

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

    1. Indoor
    2. Outdoor
    3. Flexible on Indoor/Outdoor
45. Proposed Program Fee (The City of Malibu provides 70% of the fee to the instructor). *
46. Daily/Drop-In Fee*
48. Supplies/equipment instructor will provide:*
50. Supplies/equipment that the participants will need to provide:*
54. Professional References
56. Professional Reference 1 (Name and Title)*
57. E-Mail*
59. Professional Reference 2 (Name and Title)*
60. E-Mail*
62. 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).
64. Signature*
65. Date *
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field