Special Risk Accident & Liability Insurance Enrollment Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Institution' and 'Name of Camp/Clinic' in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the 'Mailing Address' section, including street, city, state, and zip code. This ensures that all correspondence reaches you promptly.
4. Provide a 'Contact Name', 'E-Mail Address', and 'Phone Number'. This information is essential for communication regarding your application.
5. Indicate the 'Effective Date of Coverage' and 'Termination of Coverage'. These dates are vital for understanding your insurance period.
6. Complete the section regarding camper age range and describe camp activities. If you have overnight campers who are minors, answer the follow-up questions about background checks and safety standards.
7. In Part II, calculate your premium based on the number of eligible campers and days. Use the provided rates to ensure accurate calculations.
8. Finally, sign and date the form at the bottom to confirm your application. Review all entries for completeness before submission.

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