Register as a Project VisAbility Instructor

Type of Disability (describe)
Education and Training (list all that apply)
Exercise Experience (list all types)
What type of exercise do you currently do on a regular basis? How often?
Where do you exercise?
Have you participated in group exercise programs in the past? (check for yes)
Location(s) where you would like to teach
Why do you want to be a group exercise instructor?
Are you certified in basic CPR? Yes No, I'm not certified I'll get certified
Can you commit to a 6-month training program (check for yes)
Date available to begin

Do you have any health issues which would impact your ability to teach? (list and describe all that apply)
Please list anything else you would like us to know in considering your application
References (please list two people who we may contact regarding your qualifications):
Reference 1 Name Phone
Reference 2 Name Phone
By filling in your name below, you agree that all information is correct and that you are applying to be considered as a Project VisAbility instructor. You also agree to have your personal information, including your name, city, state, zip code, email address, and website URL, visible on our website and searchable by the public. Submission of this application does not imply acceptance. Project VisAbility management will review your application and respond accordingly.
I agree (type name) * Date *