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3. INSTRUCTOR APPLICATION
7. Name of Applicant:*
9. Business Name (if applicable):
11. Additional Instructor Covered Under Applicant's Insurance (if applicable):
12. Additional Instructor Covered Under Applicant's Insurance (if applicable):
14. Additional Instructor Covered Under Applicant's Insurance (if applicable):
15. Additional Instructor Covered Under Applicant's Insurance (if applicable):
17. Additional Instructor Covered Under Applicant's Insurance (if applicable):
18. Additional Instructor Covered Under Applicant's Insurance (if applicable):
20. Additional Instructor Covered Under Applicant's Insurance (if applicable):
21. Additional Instructor Covered Under Applicant's Insurance (if applicable):
23. Street Address:*
25. City:*
26. Zip Code:*
28. Phone #:*
29. Email Address:*
31. Description of Activity:*
33. Additional Comments:
35. I understand that if I received clearance to provide instruction at City of Palm Beach Gardens facilities I will be asked to complete permit applications and pay for space. *

    1. Yes
37. Please upload a headshot with a plain background to be used on your license.
39. Please upload your Palm Beach County Business Tax License.
41. Please upload your proof of insurance.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field