Health & Wellness Instructor/Partner Interest Form

We thank you for your interest in the Health & Wellness Collective. Please complete the interest form below.

I am interested in becoming:

an Independent Instructor an Organizational Partner (Programming Partner)

First Name

Last Name

Business Name/DBA

We will need an address. Would you like to provide a home or business address?

HomeBusiness

Business/Organization Name

Home Street Address

Home City

Home State

Zip Code

Business Street Address

Business City

Business State

Zip Code

Email Address

Phone Number

Website Address

Do you or your staff members have at least 1 year of experience teaching health/wellness/fitness classes?

YesNo

What target populations are you most interested? (Check all that apply):

ToddlersYouthAdultsSeniorsFamilies

Please provide the name, format, and a description of the class/service/workshop/program you would like to offer:

What location/s would you like to offer your class/service/workshop/program within the city of Atlanta (Atlanta Beltline Corridor)? (Check all that apply):

EastsideNortheastNorthwestSoutheastSouthwestWestside

Please list your qualifications: health/fitness degrees, training, and/or certifications. (If none, please write N/A)

What is your current CPR/AED certification status?:

Active CertificationExpired CertificationNever CertifiedI have certified staff members

Please share why you are interested in partnering with the Atlanta Beltline Partnership?

How did you hear about the Health and Wellness Collective/Free Fitness Program? (Check all that apply):

Website/Social MediaPersonal ReferralWord of MouthCurrent/Former InstructorCurrent/Former ParticipantAtlanta Beltline EmployeeCurrent/Former Volunteer