Traditional Tournament Application

Please complete the following application and submit to bind coverage.

If you have any questions, please email don@karateinsurance.com

or call (888) 868-1164 or (970) 390-7860

 


Please complete the Address information below.

Your Mailing Address Tournament Location Address
Address
City
State
Zip
Premium Calculation

Premium is based on the number of participants. The minimum premium is $450 which is fully earned.












If you need a copy of the waiver, please click here.


Additional Insureds

Complete this section if you need to provide evidence of insurance to a landlord, gym, municipality, school or others. 



Mailing Address: Location Address
Address
City
State
2 character abbreviation
2 character abbreviation
Zip
Click Here to Add Additional Insureds
Payment Information

The soonest we can bind your insurance is the day following receipt of payment. If you pay with a credit card, we can bind as early as tomorrow. If you mail us a check, coverage will be bound the day after we receive it. 

MM/DD/YYYY

Note: Effective February 1, 2012, all accounts using a credit or debit card will be charged an additional $10.00 service charge due to the increase in what the bank charges.

$

Once you hit the submit button below, you will be redirected to a secure payment site and you will receive an email confirmation of application. You should print this page for your records. Your insurance policies will be emailed to you within a couple of days in an Adobe/PDF format.

Each school or studio must install a Release and Waiver of Liability and Indemnity Agreement for all students and staff members. Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of any occurrence to a student or staff member. However, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the event of an occurrence to a student or staff member. A Waiver/Release form will be emailed to your school or studio upon request. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer submits application or files claim containing a false or deceptive statement may be guilty of insurance fraud. The minimum premium on this program is also the minimum earned. What this means is if you cancel your insurance, the insurance company will keep the minimum premium and not return any premium to you. Any premium about the minimum will be returned on a prorate basis if cancelled. 


Need assistance with this form?