Host Site Submission

We appreciate your interest in offering to host a certification training, seminar and/or masterclass at your facility. Completing the following information will confirm your interest, and help us coordinate a fantastic event!
Program Certification Trainings:
SCW Certifications/Programs:

3D FUNCTIONAL FLEXIBILITYACTIVE AGINGADVANCED FUNCTIONAL PILATESAQUA BARREAQUATIC EXERCISE FUNDAMENTALSBARREBOXINGCORE TRAINING SPECIALISTDEEP WATER EXERCISEFIERCE INTERVAL RESISTANCE EXERCISE (F.I.R.E.)FOAM ROLLINGFUNCTIONAL PERFORMANCEGROUP EXERCISEGROUP STRENGTHGROUP FITNESS DIRECTOR/STUDIO OWNERGROUP STEPKETTLEBELL TRAININGKIDS IN MOTIONLIFESTYLE AND BEHAVIORAL COACHINGMOMS IN MOTIONPERSONAL TRAININGPILATES MATWORKPILATES SMALL GROUPPRACTICAL GUIDE TO NUTRITION, HORMONES, & METABOLISMSMALL GROUP PERSONAL TRAININGSPORTS NUTRITIONSUPPORTED EXERCISE FOR AGELESS TRAININGT’AI CHI & Qi GONG FOR WELLNESS PROSWATERinMOTION® CERTIFICATIONWATERinMOTION® WORKSHOPWEIGHT MANAGEMENTYOGA FUNDAMENTALS IYOGA FUNDAMENTALS II
Required Information:
Contact Name*

First NameLast Name
Contact Preferred Number*

Area CodePhone Number
Contact Cell Number*

Area CodePhone Number
Contact Preferred Email*
Contact Alternate Email*
Host Facility Name*
Host Facility Phone Number*

Area CodePhone Number
Host Facility Address*
Street Address
Street Address Line 2
City
State
Zip Code
Please provide 3 date options to host the event. The dates must be at least 8 weeks out from the date of this forms submission.
1st Choice*

MonthDayYear
2nd Choice*

MonthDayYear
3rd Choice*

MonthDayYear
Facility Hours:
Thursday:*
Open to Close (Hint: 9am - 6pm)
Friday:*
Open to Close (Hint: 9am - 6pm)
Saturday:*
Open to Close (Hint: 9am - 6pm)
Sunday:*
Open to Close (Hint: 9am - 6pm)
The following requirements may be necessary to ensure the event will be as successful as possible!

Please indicate if you can provide:
1. Exclusive use of group fitness studio with mirrors for the duration of the EVENT:*

YesNo
2. Partial or exclusive use of the pool for the duration of the event:*

YesNoThere is no pool at our facility
If you answered "Yes" above, please indicate the weekend hours of pool accessibility:
Saturday Pool Availability
Sunday Pool Availability
3. Numbers of available equipment:
Bikes:
Ballet Barres (Indicate number of participants that can be accommodated) :
Yoga Mats:
Medicine Balls:
Stability Balls:
Pilates Balls:
BOSU Balance Trainer Balls:
Gliding Discs:
Small Handballs:
Jump Ropes:
Boxing Gloves (pairs):
Hand Pads (pairs):
Hand Wraps:
Free Standing Boxing Bags:
Therabands:
Ankle Bands:
Tubing:
Aqua Noodles:
6' Tables:
Folding Chairs:
Kettlebells (Indicate quantity and poundage for each):
Hand weights (Indicate quantity and poundage for each):
Other Equipment:
Indicate name of equipment and quantity
4. Other essentials that may be required for a successful event:
a. Television with red/white/yellow input jacks (to playback feedback onsite)*

YesNo
b. Flipchart & pens/markers or whiteboard*

YesNo
c. Group fitness studio sound system (CD and ipod hookup)*

YesNo
d. Headset / microphones*

YesNo
e. Pool sound system*

YesNo
f. Pool microphone*

YesNo
g. Power Point LCD projector*

YesNo
h. Screen*

YesNo
i. Drinking water*

YesNo
j. On site cafe/restaurant*

YesNo
k. Please list two local sandwich/salad shops (if available):
Name of establishment 1:
Address:
Phone:
Website
Proximity to host facility (miles/minutes by car):
Name of establishment 2:
Address:
Phone:
Website:
Proximity to host facility (miles/minutes by car):
5. Other rooms available/Associated facility name with number of individuals it can accommodate:
Main Facility Room:
Room Name and Number of participants
Yoga Room:
Room Name and Number of participants
Cycle Room:
Room Name and Number of participants
Presenter's Room:
Room Name and Number of participants
Pool:
Pool location and number it can accomodate
Lecture Room:
Room Name and Number of participants
6. Please recommend at least 2 nearby hotels. Please include phone numbers
Hotel #1*
Hotel #1 Address:*
Hotel #1 Phone Number*

Area CodePhone Number
Hotel #1 Website:
Hotel #2*
Hotel #2 Address:*
Hotel #2 Phone Number*

Area CodePhone Number
Hotel #2 Website:
7. Nearest Airport for Transport*
a. How far is the above airport from your facility? (in miles)*
b. What is the estimated travel time (one way) to your facility from the above airport?*
8. How many instructors do you have to train?*
9. If this is an application to host a training, are you planning to pay for 10 spots to guarantee the event?

YesNo
10. Has the licensing contract for this program been completed?

YesNo
11. Special Notes: If confirmed, we request that the host facility assist with transporting the trainer (pick up and/or drop off at the airport, hotel and host facility.) Please list the following:
Full Name of Person Responsible for Transportation:*

First NameLast Name
Cell Phone Number:
Work Email Address:
Personal Email Address (if different):
12. Special Requests:
Submission of this form does not guarantee a training/certification will be scheduled at your facility. Scheduled trainings/certifications may be canceled at any time by WATERinMOTION and/or SCW Fitness Education due to low registrations, trainer shortage, or weather. SCW Fitness Education and WATERinMOTION will not be responsible for any liability associated with the event including but not limited to loss, theft or damage to any and all equipment and/or materials including barbells, mats, balls, bands, aqua noodles tables, table clothes, microphones, stereo/sound equipment, carpet, flooring, etc. SCW and WATERinMOTION will also not be liable for any and all injuries related to the facility event operations, including but not limited to management, set-up, tear-down, etc.
Questions? Please contact our office at 847-562-4020.
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