General Information Business Type* Contact Address*
Contact address for you / your organization, NOT the address of where your activity is taking place
Covered Activity #1 Activity #1 - Which of the following best describes the activity you are seeking coverage for?* Will the covered activity include the same participants playing multiple sport types?* i.e a 5-day multi sport camp where the same participant group plays basketball, badminton and soccer.
Select all sports / activities that will be taking place* Are the activity dates consecutive?* Example: consecutive dates would be a 5 day single week camp that runs Monday - Friday, non-consecutive dates would be a two week camp that runs Monday - Friday both weeks but does not have activities on the weekend
Activity #1 Venue Address*
Physical location of where the covered activity is taking place
Will you be using locations other than the the venue listed above for your activities Training / Lesson activities?*
Activity #1 Participant Breakdown Do you need to add a second sport / activity?*
Covered Activity #2 Activity #2 - Which of the following best describes the activity you are seeking coverage for?* Will the covered activity include the same participants playing multiple sport types?* i.e a 5-day multi sport camp where the same participant group plays basketball, badminton and soccer.
Select all sports / activities that will be taking place* Are the activity dates consecutive?* Example: consecutive dates would be a 5 day single week camp that runs Monday - Friday, non-consecutive dates would be a two week camp that runs Monday - Friday both weeks but does not have activities on the weekend
Activity #2 Venue Address*
Physical location of where the covered activity is taking place
Will you be using locations other than the the venue listed above for your activities Training / Lesson activities?*
Activity #2 Participant Breakdown Do you need to add a third sport / activity?*
Covered Activity #3 Activity #3 - Which of the following best describes the activity you are seeking coverage for?* Will the covered activity include the same participants playing multiple sport types?* i.e a 5-day multi sport camp where the same participant group plays basketball, badminton and soccer.
Select all sports / activities that will be taking place* Are the activity dates consecutive?* Example: consecutive dates would be a 5 day single week camp that runs Monday - Friday, non-consecutive dates would be a two week camp that runs Monday - Friday both weeks but does not have activities on the weekend
Activity #3 Venue Address*
Physical location of where the covered activity is taking place
Will you be using locations other than the the venue listed above for your activities Training / Lesson activities?*
Activity #3 Participant Breakdown Do you need to add any additional sports / activities?* Does your organization have a concussion management policy, compliant with state law, that is provided to all coaches, staff, and parents/legal guardians with written acknowledgment of receipt and review?* Does your concussion policy require immediate removal of any participant suspected of a head injury and clearance by a licensed healthcare provider before return to play?* Does your organization require annual concussion recognition training for staff?* Will each intersection and road crossing be 100% controlled by the police?* Are you taking proper safety precautions by posting signage along race route and using cones to separate runners from traffic and the general public?* Will cheerleading activities include any stunts?* Will cheerleading activities include pyramids over 2.5 persons?* Will cheerleading activities include the use of any trampolines, springboards or other similar apparatus?* Will all cheerleading coaches be certified and following either USASF or NACCC guidelines for spotting/safety?* Are you seeking a quote with participant coverage (excess medical, participant liability), or just general liability to meet contractual requirements, excluding participant injury coverage?* Please confirm all participants/legal guardians of minor participants sign waivers holding your organization harmless Please confirm you have no prior insurance claims/losses or pending incidents which could result in a future claim* Will you be responsible for providing overnight sleeping accommodations for participants (e.g., sleepovers, dormitory stays, camping)?* Do you own or operate any sports facilities, studios, fields, pools, or courts on a daily basis (excluding short-term rentals)?* Will your activities include any one-on-one interactions with minors (without a 3rd person present)?* Will your activities include any live music, celebrity appearances or other forms of live entertainment?* Please confirm your activities do not include any of the following: Professional/semi-professional athletes or collegiate sports, the use of golf carts or vehicles that seat more than 12 passengers, activities at private residences or house rental properties (i.e. Air BnB, VRBO or similar), cannabis (including but not limited to edibles, CBD, etc), medical exams and/or vaccines, aircraft, food with open flames, hypnotist/magicians, fireworks/pyrotechnics, child care operations, inflatable devices/bounce houses, mechanical amusement rides, firearms or knives, live animals, tattoo/body piercing, direct contact with spectators/attendees (referring to hands on services such as massage therapy), motorsports, open water exposure, paintball, parades, pyrotechnics, rock climbing walls, rodeos, temporary skating, skiing, skateboarding, campfires/bonfires, trail rides, virtual activities.*
Additional Insured / Insurance Requirement Details Do you need to include a specific entity as addititional insured on the policy to satisfy contractual requirements?* Manager / lessor of field or facility, city/municipality, school district / school board etc
Additional Insured #1 Address*
Do you need to add another additional insured entity?* Additional Insured #2 Address*
Do you need to add any other additional insured entities?* Are there any specific general liability limits, umbrella/excess liability limits or any other specific coverages that you are being required to carry?*
Comments / Additional Remarks 
