Camp Insurance Request Form - Online Payment

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)

Please begin this request as an offline transaction, since Participant/Accident coverage is already in place.

* 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/
Volunteers		 # of
Days		 Remove

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.

No Yes

Your Information

Payment Information

(Note: the total amount above does not include transaction fees of 3.5% for credit cards and $4.00 flat fee for ACH/e-check transactions - all transaction fees are calculated at the next step when you click "Continue to Payment" below.)
(Note: coverage is void if an All-Star Camp is not sanctioned by your state's coaches association.)