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Empower Hour Program Submission Form
Please submit this form so we have all the details necessary to add your program to the upcoming season. Please complete 1 form per program. So if you offer Kickball 2 different days, submit 2 forms, thank you!
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* Indicates required question
Name (First and Last)
*
Your answer
E-mail Address
*
Your answer
Cell Phone
*
Your answer
School (what school do you want to offer this program at)?
*
Country Oaks Elem
Heritage Elem
Highland Elem
Johnson Elem
Kurtz Elem
Lakewood Elem
Oxbow Elem
Spring Mills Elem
Muir MS
Oak Valley MS
White Lake MS
Other:
What space in/at the school are you requesting?
*
Gym
Cafeteria
Classroom
Outside space
Other:
What do you need "in" the space? (Click ALL that apply)
*
Tables
Chairs
Carpeted room
Tile room
Other:
Required
Would you like to offer this Before or After School?
*
Before School (8 - 9 a.m.)
After School (4:15-5:15 p.m.)
Other:
Name of the Program?
*
Your answer
Are you a vendor/outside organization or are you an HVS staff member?
*
HVS Employee
EduStaff Employee
Outside Vendor
Other:
If you are an outside vendor, what is the name of your organization?
Your answer
Does HV Rec and Ed have a current W9 on file for your organization?
Yes
No
Other:
Clear selection
What days of the week do you want to offer?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
What grades is this program for?
*
K-5
K-2
3-5
Other:
Minimum Size for the class to run
*
Your answer
Maximum Size for the class
*
Your answer
Do you have a current contract with HV Rec and Ed with details about this program? Typically we do a 50/50 split with the program.
*
Yes
No
Other:
Please describe the program you want to offer, this will be used for the description online.
*
Your answer
Do you have any images you'd like to use to help show what this class is all about?
*
Yes, please send them to
Shannon.Loso@hvs.org
No, HV Rec and Ed can use images they find themselves
Other:
Proposed Fee for the program?
*
Your answer
Any questions?
Your answer
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