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2. Program Application
   This application is for proposing a new program/class/camp to be hosted at a MJ Parks & Recreation facility. Filing this application does not guarantee that your request will be granted. After review by MJPRD, you will be notified of the status of your request.
4. Business/Organization*
6. Primary Contact
8. First Name*
9. Last Name*
11. Mailing Address*
13. Address2
15. City*
16. State*
17. Zip*
19. Phone Number*
20. Email Address*
22. Secondary Contact
24. First Name
25. Last Name
27. Phone Number
28. Email Address
32. Program Information
    This information represents the Instructor’s “ideal,” and is intended as a starting place for discussions between MJPRD and the Instructor.
34. Program Name*
36. Program Focus*
    -- Select One --Fostering Human Development (Dance, Art, Preschool, Continued Learning, Skill Building, Nature Appreciation) Improving Health and Wellness (Fitness, Healthy Habits, Strengthening, Endurance, Stretching)Strengthening Families (Participating Together, Appreciation, Parenting Skills)Increasing Safety (Safe Habits, Prevention, Life Saving Skills, Crime Reduction)Other
37. Please Explain*
39. Course Length*
40. Number of Days per Week*
    -- Select One --OneTwoThreeFourFiveSixSeven
41. Day(s) Requested*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
43. Requested Start Date*
    Requested Start Date
44. Time(s) Requested*
46. Facilitiy(s) Requested*

    1. Small Meeting Room (25 max)
    2. Large Meeting Room (100 max)
    3. Gymnasium

    1. Amphitheater
    2. Multi Purpose Field
    3. Other
48. Please Explain*
50. Instructor's Experience/Qualifications*
    Examples: prior programs with dates & location listed or relevant education.
52. Does the instructor have any certifications?*
    -- Select One --NoYes
53. Certifications
55. Minimum Enrollment*
    Number required to host program
56. Fee Per Participant*
58. Additional Questions or Comments
62. Need for Program*
    Please list AT LEAST 3 other providers of a similar program in the community:
64. Initial Participant Petition*
    Please list at least 5 people (name, phone number, & e-mail) who have agreed to participate in this program should we offer it.
68. Publication Information
    This person is responsible for answering program questions.
70. First Name*
71. Last Name*
73. Phone Number*
74. Email*
76. Marketing & Promotions
    MJ Parks and Recreation is here to support your efforts in every way possible. We will include your program/activity in our newsletter, website, social media, etc. We do require that all advertising materials are provided by the instructor of the class. We ask the instructor to advertise as well.
78. Program Description*
    2-3 sentences for our website & newsletter.
80. Website
81. Facebook Page
83. Twitter
84. Instagram
86. You Tube Channel
87. Other
89. Promo Agreement*

    I understand that it is my sole responsibility to promote my program and promotions by MJ Parks & Rec are a bonus.

    1. I agree
91. Cross Promotion Agreement*

    Whereas MJ Parks & Recreation will provide support marketing services, I hereby agree to tag @MJParksandRec in ALL social media posts relating to classes described in this agreement. Failure to do so will result in MJPRD to cease all marketing assistance.

    1. I agree
95. User Agreement*

    I have read the Program Policies & Procedures and agree to abide by these guidelines as well as all ordinances and regulations of the City of Mt. Juliet and by all the conditions placed on the program by the Mt. Juliet Parks & Recreation Department. I do swear and affirm that all of the information given is true and complete. I understand that submitting this application does not guarantee approval.

    1. I agree
97. Indemnification*

    In consideration of the City of Mt. Juliet and the Mt. Juliet Parks & Recreation Department granting license to host a program on property owned by the City of Mt. Juliet, I hereby Indemnify and hold harmless the City of Mt. Juliet, the Mt. Juliet Parks & Recreation Department, its officers, agents, and employees from: Any claims, damages, costs and attorney fees for injuries or damages arising, in part or in whole, form the negligent or intentional acts or omissions of User, its officers, employees, and/or agents, including its sub or independent contractors, in connection with the performance of the Agreement. Any claims, damages, costs and attorney fees arising from any failure of User, its officers, employees, and/or agents, including its sub or independent contractors, to observe applicable law, including, but not limited to, labor laws and minimum wage laws. User shall pay City any expenses incurred as a result of User’s failure to fulfill any obligation in a professional and timely manner under the Agreement. I understand that I am responsible for my own general and product liability insurance. In the event that I fail to indemnify and hold harmless as herein agreed, the City of Mt. Juliet shall have full rights to defend, pay, or settle said claim on its behalf without notice to me and with full rights to recourse against me for all fees, costs, expenses, and payments made or agreed to be paid to discharge said claim. In the event of default, I further agree to pay all reasonable legal fees and expenses necessary to enforce this agreement. This agreement shall be unlimited as to amount and duration.

    1. I agree
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99. Submit

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