Student-Accident Quote Form
Please complete the following form to begin the Student-Accident quoting process. If you prefer to email any of the below referenced information, please forward to Lauren Allen at firstname.lastname@example.org
Compensation Disclaimer Compensation Disclaimer.pdf
Request For Proposal
Requested Effective Date for Quote *
CURRENT PLAN Mandatory/Blanket Coverage
Claims & Premium Report
Class I: All enrolled students of the School/School District including all sports & activities.
Class II: All interscholastic sports, including interscholastic football and cheerleading.
Class III: All interscholastic sports, including interscholastic football, band cheerleading, majorettes, intramural sports, gym classes, and non-sport extracurricular activities.
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
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