Camp Insurance Request Form

If you have any questions or issues filling out the form below, please contact us at 800-566-6479.

Certificate(s) of insurance will be issued to you via email.

Please allow up to 7 business days for processing. If you do not receive correspondence from us after 7
business days, please contact us.

Fields marked with an asterisk (*) are required.

Camp Information

No Yes
No Yes
No Yes
No Yes
No Yes

* Coverage Information for Participant/Accident (Medical)

* Coverage Information for Participant/Accident (Medical)

Maximum Accident Medical Benefit: $25,000 | Accidental Death $5,000 | Deductible: $500

Please note that Participant/Accident (Medical) coverage is mandatory.

Note: The total # of days refers to the actual participation days

Sport # of
Participants per day
# of Coaches/
# of

Camp Venue Information

Certificate Holder Information

A certificate holder is the entity requesting proof of insurance from you.

No Yes

Additional Insured Information

An additional insured is the certificate holder requiring additional insured status.

Note: an additional fee of $50.00 will apply.

No Yes

Your Information

Payment Information

Coverage is void if an All-Star Camp is not sanctioned by your state's coaches association.