Safe Kids Liability Insurance Request

Submitted by dclewis1 on Tue, 03/01/2022 - 10:40

Thank you for planning and hosting an event in your community. We are happy to be able to offer you liability coverage for your event and volunteers. Please fill out the information as completely as possible. Events submitted without ample details will not be provided coverage. Events need to be registered at least 7 days in advance. Please contact Lisa Blackmon if you have questions or concerns.

By filling this form out, coverage will be provided for your Safe Kids sponsored event.

Indicates required field

Name of Event

Event Type (bike rodeo, training, safety seat check, etc.)

First

Last

Location of Event

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date and Time Event starts

Organizing Unit Affiliation

First

Last

Emergency Contact Phone

Estimated Attendance

Community Volunteers Included

Yes

Estimated Number of Volunteers

Comments