Certificate of Insurance Request Form: Swim Alberta Association
This form is only used if a facility requests to be named on the Certificate of Insurance.
PLEASE ALLOW THREE (3) WEEKS PRIOR TO YOUR EVENT FOR PROCESSING TIME.
Club Contact Name
Club Contact Phone
Club Contact E-mail
Details of Event (What are you doing? Where are you going? Who's attending?)
Dates, if Applicable
Times, if Applicable
Numbers of: Coaches
Please list all chaperones, if applicable
Requesting Facility Information
Please provide accurate and exact information to be listed on the Certificate of Insurance.
Name of Facility &/or requesting municipality
Facility Contact Name
Is a 30 Cancellation required?
If the facility requires specific wording, enter it here. Please note that Canadian insurance verbiage is different than in the US.
Please upload a copy or scan of your contract.
A scan of your contract MUST be included with this form.
Date of Submission:
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