Purchase Camp, Instructional, Tot, Mini, Youth Insurance

"*" indicates required fields

Welcome to JVA Insurance Enrollment

Following the completion of this registration, you will receive an email with IMPORTANT INSTRUCTIONS REGARDING JVA BACKGROUND SCREEN POLICY! *It is mandatory that ALL coaches and players complete the electronic insurance waiver.

QUESTIONS? Please contact: Lisa Wielebnicki lisa.wielebnicki@jvavolleyball.org

Indoor: $1/player/coach/day

Beach: $1/player/coach/day

*Covers players and coaches per day. If your program runs longer than 10 days, use the JVA Program insurance rates instead per every 10 kids.

Your Club*

Not a JVA Member Club?

If your club is not in the above dropdown list, your club is likely not a JVA member but you still need to complete a background screen and APS Training.

Check "My Club is Not Listed" below. You will then need to enter your club, club director's name and their email to notify them that you've started the background screen process.

My Club is Not Listed

Non-JVA Member Club Information

Club Name*

You must enter your full club name. Please do not use any abbreviations.

Club City*

Club State*

Club Director Name*

First Last

Club Director's Email*

Contact Information

Name*

First Last

Phone*

Email*

Camps, Instructional, Tots, Mini, and Youth Insurance

Section 1 LIABILITY:

Carrier – International Insurance Company of Hannover
- Occurrence: $1,000,000
- Aggregate: $5,000,000
- Fire Damage: $100,000
- Products/Completed Operations: $1,000,000
- Personal/Advertising: $1,000,000
- Spectator Medical Expense: $5,000
- Physical/Sexual Abuse Option: $50,000/$100,000
--Non-Owned Auto Option – EXCLUDED (Can be added for separate premium upon approval)
--Sports Equipment Option – EXCLUDED (Can be added for separate premium upon approval)
Policy Term – Limited to Dates of League Play

Section 2 EXCESS ACCIDENT:

Carrier – AXIS Global Accident & Health
- Excess Accident Limit: $25,000
- AD&D: $2,500
- Deductible: $ 250
- Dental: $1,500
Policy Term – Limited to Dates of Season Any administrative fees added have been applied to the rates above.

Has there been any prior claim or incidents of alleged physical/sexual assault within your club?:**

Liability insurance includes Sexual Abuse & Molestation coverage. Please verify this statement.

Yes

Event Information

Name of Camp*

Camp Director(s)*

Please list all directors if more than one.

Additional Certificates or Endorsements:**

Only list those entities that contractually require you to name them as an additional insured on the policy. We will only honor such requests that are made by the league contact. Note that the certificates will not be sent directly to these entities – they will be sent to you for delivery. (If you do not provide the complete mailing address of the Additional insured(s) we will not be able to issue the certificate). Your insurance premium includes all additional insured (s) that are landowners, field locations or sponsors at policy inception. Special endorsements or specific certificate wording, as required by the additional insured, may incur an additional charge.

How many Camps, Instructional, Tots, Mini, and Youth Locations?*

Please enter a number greater than or equal to 1.

List All of Your Tournament/League Locations with their Address and Contact*

Name of Facility

Address

Contact Name

Contact Phone

Insurance Purchase

Insurance Type (Camps, Instructional, Tots, Mini, and Youth)*

Indoor: $1 / per Player / day

Beach: $1 / per Player / day

Total Days?*

(Camp / Instructional / Tot / Mini / Youth)

Please enter a number greater than or equal to 1.

Total Players?*

(Camp / Instructional / Tot / Mini / Youth)

Please enter a number greater than or equal to 1.

Total Coaches*

(Camp / Instructional / Tot / Mini / Youth)

Please enter a number greater than or equal to 1.

Calculated Insurance Cost*

Price: $1.00

*Includes processing fee

List All Dates the Program Covers Individually*

Enter MM/DD/YYYY format

Final Insurance Cost

Credit Card

Card Details

Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

Purchase Camp, Instructional, Tot, Mini, Youth Insurance

Welcome to JVA Insurance Enrollment

QUESTIONS? Please contact: Lisa Wielebnicki lisa.wielebnicki@jvavolleyball.org

Non-JVA Member Club Information

Contact Information

Camps, Instructional, Tots, Mini, and Youth Insurance

Section 1 LIABILITY:

Section 2 EXCESS ACCIDENT:

Event Information

Insurance Purchase

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