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City of West Sacramento

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Table of Contents

1. What are the core values and mission objectives of the West Sacramento Parks & Recreation Department? ... 4-5

2. What is an Instructor and why teach? ... 5 3. What do I have to do to become an Instructor? ... 5-8

Submit a course proposal

Pass a fingerprint/background check

Show proof of current CPR and First Aid training Insurance

Obtain a business license

Agree to follow all City Policies and Procedures

4. What are the Parks & Recreation Department Policies and Procedures? 8-9

City of West Sacramento – Customer Service Philosophy American with Disabilities Act (ADA)

Instructor’s Relationship with Participants Safety of Participants

Students with Special Needs

Releasing of Minors and Participants with Special Needs Discrimination and Harassment

5. How will the Parks & Recreation Department monitor Instructors? ... 9-10

Review Progress Reports Inspection

Review of Complaints

Review of end-user satisfaction

6. How is registration, fees, and refunds handled? ... 10-11

Course Calendar Registration Non-Resident Fees

Administrative Processing Fee Refunds

Transfers

Course Cancellation

7. How do I manage the logistics of the class? ... 11-12

Liability Waivers and Orientation to Program Program Rosters Program Visitors Program Changes Program Evaluations Promotion Management of Facilities

8. When do I get paid? What about taxes? Can I store equipment? ... 12-13

Administration Payroll Schedule Storage of Equipment

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3

In Case of an Emergency: Names and Numbers Locations of Alarms and Emergency Equipment Incident Report

Accident Report

Workers Compensation Claims

10. What is a Volunteer Instructor?...14

What Do I need To Do To Become a Volunteer Instructor?

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1. What are the core values and mission objectives of the West Sacramento

Parks & Recreation Department?

Thank you for your interest in becoming an Independent Contractor hereinafter called “Instructor” with the City of West Sacramento Parks & Recreation Department. We are excited about the possibility of working together to reach our common goals and to serve our community. The Parks & Recreation Department is dedicated to building strong individuals, families and communities through providing recreation opportunities. In saying this, we are stating a belief that the benefits of participating in social recreation programs, classes and events extend beyond the activity itself into the creation of community.

O

UR

P

ROFESSION

'

S

C

ORE

V

ALUES

Values we as professionals share as members of the West Sacramento Parks & Recreation family:

Inclusively • Accessibility • Diversity of Experience • Service to Community • Professional Growth • Personal Development • Healthy lifestyles • Fun and Celebration • Lifelong Learning • Environmental Stewardship

O

UR

P

ROFESSION

'

S

M

ISSION

O

BJECTIVES

The mission objectives of recreation and park professionals in California describe both why our Parks & Recreation Department exists and the benefits it can foster in the community.

The objectives of the West Sacramento Parks & Recreation Department are to:

Strengthen community image and sense of place • Support economic development • Strengthen safety and security • Promote health and wellness • Foster human development • Increase cultural unity • Protect environmental resources • Facilitate community problem solving • Provide recreational experiences

Our vision is to Create Community through Our People, Our Parks and Our Programs.

Particular to West Sacramento Parks & Recreation is our desire to provide programming which captures the unique interests and shares the rich experience of members of our community. As such, Parks & Recreation offers programs which include a wide variety of health and wellness topics, lifelong learning opportunities, nutrition education, recreation/special events and supportive services.

This manual explains the policies that must be followed in your work with the City of West Sacramento Parks & Recreation Department, the policies and procedures for managing your activities as an Instructor, and, most importantly, what you need to know about handling an incident or emergency. The information in this booklet is intended for interested Instructors and current Instructors. The booklet is a resource for information related to teaching a "fee" based class for the West Sacramento Parks & Recreation Department.

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5 “People talk about finding their lives. In reality, your life is not something you find– it is something you create.”

- David Phillips

The West Sacramento Parks & Recreation Department is a progressive city, committed to providing recreational and leisure pursuits throughout the new millennium. What can the department offer you as an Instructor? Here are just a few features that our department can offer you.

The West Sacramento Parks & Recreation Department has beautiful facilities. The Recreation Center (gym, group exercise room, and three (3) community rooms), the Boathouse, and the Community Center are available all year for classes and workshops. These facilities are maintained to assure the comfort of Instructors and participants.

The City of West Sacramento Parks & Recreation Department utilizes Instructors to provide recreational services to our community. Programs may be designed for preschoolers, school age children, teen, families and active aging adult(s).

3. What do I have to do to become an Instructor?

S

UBMIT A

C

OURSE

P

ROPOSAL

An Instructor submits a course proposal to Parks & Recreation. This proposal is reviewed by the Recreation Supervisor to determine its potential in meeting the Department’s goals and vision. If the proposal is determined to be consistent with the Department’s goals and vision, then the suitability and availability of the facility, fee structure, time frames for the course, maximum and minimum participation, age range and course descriptions are all discussed. Once a verbal agreement is reached, an agreement is produced which states the specifics for each course and service. A sample agreement is included as Attachment A.

The process is simple. Attachment C is the course proposal form that you will need to submit. Please fill out these pages and return them to the Parks & Recreation office. Keep the booklet for future reference.

1. Two (2) descriptions are needed. The first one describes your program in detail. The Parks & Recreation Department wants to know what goes on in your class. The second is a written description to sell your program to the public on the website and any printed publications.

2. You must include the dates of your class. You must be specific. Do not leave them blank because a Staff member will not call you for the dates. All facility information is now computerized, and dates need to be entered before a conflict can be detected.

3. You must compute your own price. IRS rules regarding contracting for classes prohibits the Department from setting your price. You can figure your rate in the following way:

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are added on top of the base fee, but the additional fees will not be split, see section 6). A staff member can walk you through this process if needed.

4. Classes for which the West Sacramento Parks & Recreation Department will not accept proposals for are as follows:

a. Programs that are similar to programs we currently offer (you should look at the City’s website at www.westsacfun.org.)

b. Programs we have offered in the past that were cancelled, unless you can show that you have the necessary number of participants who are interested.

5. Submitting a proposal does not guarantee that the class or activity will automatically be added to the West Sacramento Parks & Recreation Department’s public recreation offering. Additionally, once added, no guarantees are made that the West Sacramento Parks & Recreation Department will automatically continue offering the activity or program.

P

ASS A FINGERPRINT

/

BACKGROUND CHECK

All Instructors who instruct classes for minors will be required to pass a criminal background check. A memo will be sent to you when your proposal has been accepted; outlining the steps you need to take to be fingerprinted. This cost is a cost that is paid by you, the Instructor. You must take a form filled out by the West Sacramento Parks & Recreation Department to the Police station or Department of Justice with you at the time of your fingerprinting.

S

HOW PROOF OF CURRENT

CPR

AND

F

IRST

A

ID (Parks & Recreation must always have a current copy on file)

I

NSURANCE

(

REQUIRED IF OFF SITE

)

As an Independent Contractor for the West Sacramento Parks & Recreation Department, there are a few things you should know about liability and insurance.

1. The West Sacramento Parks & Recreation Department is a member of YCPARMIA, Yolo County Public Agency Risk Management Insurance Authority.

2. The Risk Management Authority is the insurance company for the Park Department and not for the people or businesses with whom we contract. The Authority is there to protect the City of West Sacramento and its departments, and to provide insurance coverage for the departments in the insurance pool. Therefore, the Department’s insurance will not defend or pay out on claims brought against an Instructor of the Department.

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4. It is also important that you understand that the agreement with the Department does not equal employment. You will be under contract as an Instructor, and are not entitled to the wages or benefits associated with full or part-time employment with the City of West Sacramento. While an Instructor may seek employment with the City, your status as an Instructor does not give you any ‘special consideration’ prior to, during or after the recruitment process.

5. Contractors that use their own facility (not a City facility) are required to provide a certificate of liability insurance naming the City as additionally insured.

There is one thing you can do to protect yourself. Obtain liability insurance. Any contractor not actually required to carry insurance should evaluate his or her own circumstances before determining if you will choose not to carry liability insurance. Keep in mind that the lower the risk, the lower the premium, and if there is a high premium, it probably is because the risk is higher; therefore your exposure to the loss is higher.

O

BTAIN A BUSINESS LICENSE

o Do all contractors/Instructors need a business license? Yes

o Where do you go to get a Business License? The City of West Sacramento Finance Department

which is located next to the Parks & Recreation counter.

o How long does it usually take to process a business license? Approximately 2 weeks

o What does a contractor/Instructor do if their “business/home office” is outside of West Sacramento? There is a business license application packet especially for non-local vendors. If

they have a business license from the city where they are located and can provide a copy with their application packet, the fee is waived. If not, it is $40 per year.

o What are some benefits for the contractor/Instructor to get a business license (besides the fact that they need one)? There may be tax benefits for operating a home based business, but

please contact a CPA to find out more information. You can also contact the Small Business Administration for more information.

o Does a Business License have to be renewed yearly? Yes o Is there a cost for renewal? Yes, $40

o Do I get a notification? Yes, the Finance Department will send a renewal form to the address on

the application.

A

GREE TO AND PRACTICE THE CUSTOMER SERVICE PHILOSOPHY

(

SEEN IN SECTION

4).

4. What are the Parks & Recreation Policies and Procedures?

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C

ITY OF

W

EST

S

ACRAMENTO

--C

USTOMER

S

ERVICE

P

HILOSOPHY

Instructors are expected to represent the City of West Sacramento with professional conduct. To some participants, the Instructor is the only representative of the City they will see. Instructors must conduct themselves in a professional manner including dressing and speaking professionally, and supporting city policies and decisions. Department staff will host periodic Customer Service trainings for all paid staff and encourage Instructors to attend one of the one (1) hour sessions to gain a better understanding of our customer service philosophy.

A

MERICAN WITH

D

ISABILITIES

A

CT

(ADA)

The ADA is federal legislation, which guarantees equal opportunity for individuals with disabilities in employment, public accommodations, transportation, local and state government services and telecommunications.

It is the policy of West Sacramento Parks & Recreation Department to fully comply with the provisions of the ADA, and to make reasonable accommodations to individuals with vision or hearing impairments or other disabilities so that they can have an equal opportunity to participate, unless an undue burden would result. Physical barriers must be removed if removal is readily achievable (i.e. easily accomplished and able to be carried out without much difficulty or expense). If not, alternative methods of providing the services must be offered. Public accommodations may not discriminate against an individual or entity because of the known disability of an individual with whom the public entity or its representatives is known to have a relationship or association.

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ELEASING OF

M

INORS AND

P

ARTICIPANTS WITH

S

PECIAL

N

EEDS

At the end of the activity time, the Instructor must not release children or participants with special needs to anyone other than the authorized parent, or guardian (for special needs, the person may be release to his/her attendant). Never release a child or individual with special needs to someone who is unknown or of whom the participant expresses fear or uncertainty. The Instructor must stay until all participants have left the facility.

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NSTRUCTOR

S

R

ELATIONSHIP WITH

P

ARTICIPANTS

The Instructor must not have contact with a single participant unobservable by other staff, parents or participants at anytime. Parents and/or caregivers should be invited and encouraged to visit program sites at anytime on a drop-in basis and do not need to ask permission to do so.

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AFETY OF

P

ARTICIPANTS

/I

NSTRUCTORS

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D

ISCRIMINATION AND

H

ARASSMENT

The City of West Sacramento has a strong policy against any form or type of discrimination and harassment by, among, or to its representatives. Discrimination and harassment can be defined as any behavior that is disrespectful and causes discomfort to another person, be it physical, verbal, visual, or sexual. Instructors are responsible for their own actions/conduct, and must never engage in discrimination and harassment.

5. How will the Parks & Recreation Department monitor Instructors?

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EVIEW

P

ROGRESS

R

EPORTS: The West Sacramento Parks & Recreation Department may review reports and records of the contractors, consultants, and concessionaries. These are typically required for submission on a specific date and covering a previously established time period. Instructors may be required to supply reports including such information as the number of programs or activities conducted and attendance at each function, revenue and expenses for each cost center, noteworthy events or problems, work accomplished, and important future work or activities.

I

NSPECTION: The West Sacramento Parks & Recreation Department will periodically inspect the work of Instructors. Inspections usually include a rating instrument with space provided to comment on the quality and quantity of services and to identify any obvious or hidden problems. The inspection can be completed with or without the contractor’s knowledge and can be completed by internal staff, other professionals, or volunteers.

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EVIEW OF

C

OMPLAINTS: A third monitoring approach is to review complaints regarding the performance of the Instructors. Most dissatisfied people do not complain but simply quit using or seek alternative service providers. Thus, the West Sacramento Parks & Recreation Department will be vigilant in seeking out and addressing complaints.

R

EVIEW OF END

-

USER SATISFACTION: A final monitoring technique is a user’s or citizens’ survey, which this Department reserves the right to conduct. This may take the form of a printed survey handed to the participants and collected afterwards, dropped off at the front desk, or returned via mail; electronically (via Internet, email or phone call); or face-to-face dialogue with a staff person. Directly asking individuals what they believe to be the quality or quantity of the service may provide a much broader perspective than can be summarized by staff alone. Users of services are most knowledgeable of their own level of satisfaction with services and what can be done to improve the quality of operations.

6. How is registration, program fees, & refunds handled?

R

EGISTRATION

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N

ON

-R

ESIDENT

F

EES

If a participant does not live in West Sacramento, an additional $5.00 per person is added to the fee, this fee will not be part of the Instructors percentage split.

A

DMINISTRATIVE

P

ROCESSING

F

EE

The West Sacramento Parks & Recreation Department imposes an administrative processing fee to individuals who sign up for classes in the West Sacramento Parks & Recreation Department. The administrative processing fee is an additional $2.00 added to the activity fee. You, as an Instructor, will not receive the administrative processing fee portion collected. This is a surcharge that is imposed by the West Sacramento Parks & Recreation Department to offset our registration software cost.

R

EFUNDS

Participants wishing for refunds or transfers to another class should be referred to the Parks & Recreation office. Current policy allows refund requests received if the Parks & Recreation is notified five (5) business days before the start of the class.

No refunds will be granted if notification is received less than five (5) full business days before the start of the class, unless a written medical verification is provided from your primary physician for the injury or illness.

T

RANSFERS

Participants who wish to transfer from one program to another may do so before the class begins, but there are no guarantees there will be space available in another class.

C

OURSE

C

ANCELLATION

Occasionally a course must be canceled due to insufficient enrollment. The Instructor is informed of this no later than one (1) full working day prior to the scheduled start of the program and earlier if at all possible. Every attempt is made to give potential students an ample amount of time to enroll in the class, as well as, anticipate the inevitable students who sign up the day of the class. In the event that a course needs to be cancelled by part of the Instructor, the Instructor must contact the West Sacramento Parks & Recreation Department as soon as possible. The Parks & Recreation staff will be responsible for contacting the participants regarding all course cancellation, rescheduling, transfers, or refunds.

7. How do I manage the logistics of the class?

L

IABILITY

W

AIVERS

[

AND

O

RIENTATION TO

A

CTIVITIES

]

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activity until you know that they are registered and have signed a waiver. Please direct these individuals to the front office, where we will help them fill out the required form in a timely manner.

In all cases, students should be encouraged to come to you, first, with any questions or concerns they may have about the activity. If there are any concerns that you feel you cannot answer, please feel free in directing them to the front office, where Parks & Recreation staff will endeavor to assist them further.

C

LASS

R

OSTERS

A list of all course participants should be provided by the Parks & Recreation office prior to the start of each course. It is the Instructor’s responsibility to verify the class roster.

If your class has not reached maximum enrollment, please discuss options for increased publicity with your supervisor. Efforts can be made to send out press releases, however, this requires lead-time to ensure the publicity is provided before the class starts. It is important to keep the participant information on this roster up to date. Please take attendance at each class meeting using the class roster. Roster Attendance Sheets must be turned into the Parks & Recreation staff after each class.

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LASS

C

HANGES

The Parks & Recreation alerts students to changes in dates or class time by including class dates, holidays and planned absences in the promotional material. However, if changes occur after publication, Instructors are also expected to remind students of deviations from the regular program format with signs and verbal announcements at the beginning and end of the activity the week before the expected change.

C

LASS

E

VALUATIONS

Periodically evaluations of courses and Instructors are conducted to guide offerings and enable Instructors to improve the content. The Parks & Recreation staff will always consult with the Instructor, prior to an evaluation. Instructor input is welcome on timing and focus of the evaluation, and the questions included. Instructors are encouraged to read the completed evaluations, which are kept on file in the Parks & Recreation Office. We respect the privacy of our clients, and therefore names, telephone numbers and other information that would identify the respondent are not included.

If you would like to have an evaluation of your class, please contact the Recreation Supervisor with whom you coordinate your class offerings to develop or adapt an evaluation form to respond to the objectives of the proposed evaluation.

P

ROMOTION

Online – All programs will be placed online at www.westsacfun.org , in the Parks Department Playbook (if feasible) and in our registration system.

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12 Additional Promotions – Instructors are responsible for any other promotions. All promotions must be approved by Parks & Recreation before distribution.

M

ANAGEMENT OF

F

ACILITIES

The Instructor is responsible for equipment and facility while in use. The Instructor is the first person to arrive, in order to ensure appropriate class set-up, and the last person to leave. Before you exit the building notify other occupants that you are leaving. At the end of the class, equipment must be placed in designated storage areas.

The Instructor is also responsible for ensuring that the class responds appropriately to fire alarms, and other emergencies.

8. When do I get paid, & what about taxes? Can I store equipment?

P

AYROLL

S

CHEDULE

You will get paid in the next billing cycle after the class ends. If you do not receive payment within four (4) weeks after your class has ended, please contact the Parks & Recreation Department to check on the status. Please notify the Parks & Recreation Department if you have any contact information changes as soon as possible.

T

AXES

Instructor income is reported to state and federal income tax via form 1099, with no tax with-held.

P

URCHASING AND

S

TORAGE OF EQUIPMENT

The Instructor is responsible for communicating equipment needs and problems with the Parks & Recreation. In the discussion about the agreement, the equipment needs should be identified. If these are to be purchased by the Parks & Recreation, arrangements will need to be made with the Department and funding secured.

9. How do I handle an emergency?

I

N

C

ASE OF

E

MERGENCIES

:

N

AMES AND

N

UMBERS

EMERGENCY:911

WEST SACRAMENTO POLICE NON-EMERGENCY: (916) 375-6474

WEST SACRAMENTO PUBLIC WORKS: (916) 617-4850

WEST SACRAMENTO FIRE DEPARTMENT: (916) 375-6474

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L

OCATIONS OF ALARMS AND EMERGENCY EQUIPMENT

Fire Alarms and Extinguishers: Fire extinguishers are located at all recreation facilities.

I

NCIDENT

R

EPORT

Occasionally, interpersonal problems, accidents, and other incidents occur in class which must be documented – for your protection as well as that of class participants, staff and the general public. The City of West Sacramento Incident Report Form has been included in Attachment D. Please fill out the form as completely as possible, and submit completed incident report within 24 hours to the Recreation Supervisor for occurrences such as fighting, theft, drugs/alcohol, physical assault, damage and trespassing.

A

CCIDENT AND

F

IRST

A

ID

P

ROVISION

Despite our attention to safety, sometimes people get hurt; when this happens it is essential that you complete an Accident Report Form (see Attachment E). Even if the injured party is in the family of the student, or a passerby, the form should be completed to provide necessary follow-up (and documentation if needed in the event of litigation). All Accident forms must be turned into the Recreation Supervisor within 24 hours of occurrence.

It is the Instructor’s responsibility to know where the first aid kit is located for all facilities in which they provide services. Please purchase your own first aid kit and bring to all classes. For minor first aid (bands-aids, etc) the first aid kit will be suffice and you MUST fill out an Accident Report even if you handed out a band-aid. For serious accidents, DO NOT MOVE the injured participant, call 911. If a minor is involved, notify the

parent/guardian immediately. For all accidents, notify the West Sacramento Parks & Recreation Department and submit the Accident Report as soon as possible.

What is a volunteer instructor?

A volunteer instructor is identical to an Instructor in all aspects with the exception of fees, payments, insurance and business license requirements. All Volunteer Instructors will be required to follow the same processes and will be held to the same professional standards as an Instructor, which are outlined in the Independent Contractors Instructors Handbook.

What do I need to do to become a Volunteer Instructor?

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UBMIT A

C

OURSE

P

ROPOSAL

(

AS SEEN IN SECTION

3)

P

ASS A FINGERPRINT

/

BACKGROUND CHECK

(

AS SEEN IN SECTION

3)

S

HOW PROOF OF CURRENT

CPR

AND

F

IRST

A

ID

(

AS SEEN IN SECTION

3)

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CITY OF WEST SACRAMENTO

PARKS &RECREATION DEPARTMENT

1110WEST CAPITOL AVE

WEST SACRAMENTO,CA 95691

(916)617-4620

UPDATED:

INDEPENDENTCONTRACTORAGREEMENT

The Independent Contractor hereinafter called “Instructor”, enters into an independent contract agreement hereinafter called “Agreement” with the City of West Sacramento as an Instructor, and makes the following representations and agrees to do the work described in the course outline attached in accordance with the following terms and conditions:

Instructor Name: Program:

Day and Dates: Time Offered: Location:

Scope of Services: The services to be rendered by the Instructor are fully and completely described in the attached course proposal. The course proposal is an essential part of this agreement, and is to be considered binding. The course proposal was designed by the Instructor and approved by the West Sacramento Parks & Recreation staff in charge and agreed to and understood by both Instructor and the City.

Payment: Completion of the above-described services is a condition of payment. As consideration for the services described above, the City agrees to pay the Instructor _____% of the total fees (not including non-resident and administrative charges).

A minimum of _________ registered participants and no more than _________ will be allowed.

Note: Any changes in the fees which are mutually agreed upon by and between the City and the Instructor shall be in the form of a written amendment to this Agreement.

Program fee per participants is _______.

This fee payment shall constitute full payment for services rendered under this Agreement. There shall be no compensation for extra or additional work or services by Contractor unless approved in advance in writing by the City. The Instructor’s fee shall provide his/her own personal tools and supplied at his/her own cost and expense. Payment hereunder shall be due and payable during the next City of West Sacramento payable cycle. The payment shall be made within 30 days of the completion of the program or within the payable cycle following the end of a program month.

Termination: This Agreement may be terminated by the Parks & Recreation Department by giving ten (10) days written notice to the Instructor. In such event, the Instructor shall be reimbursed for services rendered on a prorated basis. Should the Instructor terminate services for reasons other than extreme emergency, such as illness, or otherwise fail to perform duties of this program, this Agreement will be null and void and no moneys shall be paid to the Instructor. In the event the Instructor cannot provide services, he/she must inform the Parks & Recreation Department with 24-hour notice at (916) 617-4620 and program hours (specified above) may be prorated.

Expectations of Contractor: The contractor must be on time and set-up must be complete ten (10) minutes prior to program start time. If for any reason (beyond an extreme emergency) the Instructor is late, the City may penalize the contractor by issuing a 5% deduction in the percentage split. Being late a second or third time may be cause for termination of Agreement and forfeit of payment. The amount of time the Instructor is late will be added to the end of the day’s lesson. Instructor shall give any public relations materials to the West Sacramento Parks & Recreation Department prior to distributing for departmental approval. Instructor must wear the appropriate safety gear when implementing the class. Every participant must be wearing all safety equipment in order for the Instructor to teach the individual who has registered for the program.

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Insurance Coverage: The City requires liability insurance coverage for some classes. If insurance is required, this Agreement will not become effective until the City has determined that the insurance requirements have been satisfied.

Insurance is required Insurance not required, but strongly recommended Insurance satisfied

Substitutes/Assistants/Volunteers: Instructor has agreed that the services called for in this agreement are personal services, and the Instructor shall not assign this Agreement to another substitute or assistant. The Parks & Recreation Department must be notified of all substitutes and assistants. The substitute/assistant must be hired as an Independent Contractor with the City of West Sacramento and the City of West Sacramento will be responsible for the substitute’s remuneration. Notwithstanding the foregoing, under no circumstance shall a substitute conduct a specific class on a regular basis. All volunteers must complete the City of West Sacramento volunteer application and clear a background check before volunteering for the program.

Indemnification: Instructor shall indemnify, defend, and hold harmless the City, its offices, agents and employees from and again any and all claims, demands, liability, costs, and expenses, including court cost and reasonable attorneys' fees arising out of injury to or death of any person or persons or loss of or damage to any property resulting in any manner from the willful or negligent act of the Instructor.

The undersigned has read and understands this agreement and agrees to abide by said document.

ACTION BY INSTRUCTOR

Signature(s): Date:

Name: Social Security No.: (Please print clearly)

Address # Street City State Zip Code

Telephone (Work) (Home)

ACTION BY THE CITY OF WEST SACRAMENTO

Director of Parks & Recreation (or his/her designee) Date

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For office use only: Date entered: _______ Staff initial: _______ Revised 12/16/08

City of West Sacramento Parks & Recreation

1110 West Capitol Avenue, First Floor ● West Sacramento, CA 95691 Phone: (916) 617-4620 ● Fax: (916) 372-5329

Registration Form

Parent/Adult Contact (Main Account Holder) Information:  NEW Account  Change of Information Name (Last, First): _____________________________________________ Email: _____________________________________ Street Address: ___________________________________________ City: _________________________ Zip: _____________ Home Phone: _______________________ Work Phone: _______________________ Cell Phone: ________________________ Financially Responsible Party: _____________________________________________ Home Phone: ______________________ If different than main account holder

Emergency Contact (not parent): ______________________________ Relationship: ______________ Phone: ______________ Emergency Contact (not parent): ______________________________ Relationship: ______________ Phone: ______________ Are there any specific accommodations desired/needed to provide the fullest participation in this activity (as related to medical condition, medicine, allergies; and/or developmental, physical, mental, learning, hearing, visual, or other specific considerations)?:  YES, please explain: ___________________________________  NO If YES, please arrange an appointment after registration to further discuss appropriate accommodations. Our goal is to insure the fullest involvement and benefit possible to all participants.

Participant Name Gender Birth date Activity # Activity Name Dates Fee

Waiver of Liability, Medical Release, and Indemnification Agreement for Minor and Adult Participant Total Fees:

In consideration for myself and my minor child(ren) being permitted by the said City to participate in the above listed activity (a more detailed description can be found in the registration system under the activity number and will also be available on your activity receipt) each of us hereby waives, releases, and discharges any and all claims for damages for personal injury, death, or property damage me or my minor child(ren) may sustain or which may occur as a result of my or my minor child(ren)’s participation in said activity. I understand and agree that:

1. This release is intended to discharge in advance the said City (its officers, employees, or agents) from and against any and all liability arising out of or connected in any way with the participation of me or my minor child(ren) in said activity, even though that liability may arise out of negligence or carelessness on the part of said City (or its officers, employees, or agents).

2. Each of us understands that the described activity may be of a hazardous nature and/or include physical and/or strenuous exercise or activity;

3. That serious accidents occasionally occur during the above-described activity; and that participants in the described activity occasionally sustain mortal or personal injuries and/or property damages as a consequence thereof;

4. Knowing the risks involved, nevertheless each of us agrees to assume all risks of injury and to release and hold harmless the said City (its officers, employees, or agents) who through negligence or carelessness might otherwise be liable to me or my minor child(ren). It is further understood that this waiver, release and assumption of risk is to be binding on the heirs and assigns of the undersigned.

5. Each of us further agrees to indemnify and to hold the said City (its officers, employees, and agents) free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage which myself or my minor child(ren) may sustain while participating in said activity.

6. I certify that I have custody or am the legal guardian of said minor by court order.

7. I further agree to reimburse or make good any loss or damage cost that said City (its officers, employees, or agents) may have to pay if any litigation arises on account of any claim made by myself or my minor child(ren) or by anyone on behalf of said minor.

8. I agree that in the event said minor requires medical or surgical treatment while under the supervision of said City's recreation personnel in connection with the described activity, such supervisor may authorize treatment.

9. I also agree to pay all medical, hospital, or other expenses which said myself or my minor child(ren) may incur as a result of such treatment. 10. I expressly permit said minor child to travel by private automobile to activities and events related to the described activity.

11. Activities are not child care as defined by the State of California.

12. I give consent to the City of West Sacramento to photograph or videotape me or my minor child(ren). I understand the pictures or video may be included in the promotion of all City programs.

13. RECREATION CENTER PASS: I,_____ (initial) further agree this waiver is valid through December 2010.

I have carefully read this Waiver of Liability, Medical Release, and Indemnification Agreement, and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the said City and I sign it of my free will.

______________________________________________ _____________________________ __________________ Signature of Participant (Parent/Guardian if under age 18) Printed Name Date

______________________________________________ _____________________________ __________________

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17

City of West Sacramento

COURSE PROPOSAL FORM

Directions: Please complete the following information. Attach resume and copy of required certifications and return to:

West Sacramento Parks & Recreation Course Proposal

1110 West Capitol Avenue West Sacramento, Ca 95691

A. Applicant experience/background in proposed program – Include relevant certifications and years of experience:

____________________________________________________________________________________________________ ____________________________________________________________________________________________________ _____________________________________

B. Experience in working with the public (include paid and volunteer):

____________________________________________________________________________________________________ ____________________________________________________________________________________________________ _____________________________________

C. References:

Name Relationship Address Phone

1. 2. 3.

< more on next page >

1. INSTRUCTOR INFORMATION (PLEASE print or type) Date / / .

Name:

Address: City: State: Zip:

Phone: Day :( ) Eve: ( ) Email: Proposed Course Title:

AND/OR

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18

2. PROGRAM INFORMATION

Proposal for __________________________________________________ (Title or Activity)

A. Detailed Course Description. For additional space, please continue on the back or a separate piece of paper. _________________________________________________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ B. Course Objectives. __________________________________________________________________________ ______________________________________________________________________ C. Learning Outcomes (what will the participant learn/benefit by participating) ________________________________________________________________________ _____________________________________________________________________

Please list a four-sentence description of your program that will appear in marketing material: _____________________________________________________________________

_____________________________________________________________________ ________________________________________________________________________ Desired activity length:

a. Program/Participant meets... One day workshop

Once a week for (1 2 3 4 5 6 7 8 9 10 11 12) weeks

Twice a week for (1 2 3 4 5 6 7 8 9 10 11 12) week Other: ____________________________________

b. Length of activity (hours): _________________

c. Desired days of the week and time to conduct (if applicable):

1st choice of Day: Time: am or pm to am or pm

2nd choice of Day: Time: am or pm to

d. Suggested per person activity fee:

am or pm < more on next page >

e. Suggested materials fee (if applicable): $

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19 g. Enrollment Required (if applicable): Minimum Maximum

h. Age Requirement:

i. Any experience or prerequisites required of participants before taking the class?

j. Facility desired:

k. Equipment needed (tables, chairs, etc.):

**** If your proposal has potential for meeting our programming needs, you will be invited for an oral interview. If your program is accepted you will be required to attend an orientation and complete all necessary paperwork before the program will be offered through the Department.

Note: Contractors are required to have current CPR and Standard First Aid Certifications before program begins unless otherwise stated.

% of Revenue: On site programs - Contractor: 65% City: 35%

OFFICE USE ONLY

Date Received: Reviewed by:

Comments:

Interview scheduled: yes no INSTRUCTOR ACKNOWLEDGMENT

I acknowledge that I have read, accept and understand the information and conditions that involve me or my company contracting as an Independent Contractor with the West Sacramento Parks & Recreation Department.

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References

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