Camp Insurance Form

Please complete as much of this form as possible.

Contact Information
What's the name of the program?
Contact Person*
Email Address*	A value is required.
Address
City
State
Zip Code
Business Phone*	A value is required.
Mobile Phone:

Camp Information (if applicable)
How long have you been in business?
If you are a new camp, what's your background?
Do you own any property?	Yes No
If yes, what's the address?
Who insures you now?
What's your renewal date?
Approximately how many campers (average per day)?
Approximately how many staff?
What kind of program is this? (EX: Sports, drama, general day camp)
What is your opening day?
What is your closing day?
Feel free to include comments about camp dates or program

Insurance Information
What type of insurance are you interested in? (Please check all that apply)	All Lines General Liability Property Automobile Workers Compensation Camper Medical Excess Liability Other

How did you hear about us? Provide detail in the field below	Radio Advertisement Friend Camp Search Engine Other