Become an Instructor

Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Room set-up requirements

Tables

Chairs

No set up needed

Where would you like to hold the program?

Ballroom (200 max capacity)

Art Room (25 max capacity)

Dance Studio (50 max capacity)

Conference Room (10 max capacity)

Kitchen (10 max capacity)

Day(s) of the week to hold the program:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Start Time

Hour

Minute

Second

AM PM

End Time

Hour

Minute

Second

AM PM

Participation Waiver *

I, the undersigned participant, desires to participate in the Montpelier Center for Arts & Education programs and all special events, hereby release and agree to indemnify and save harmless Montpelier Center for Arts & Education, their employees, and any official of the special activity from any and all claims of any nature for illness, injury or loss that may result in such participation or preparation for such participation.

I agree