Residential and Day Camp Questionnaire - Morrow Insurance Agency, Inc.

Organization Name *

Address *

City *

State *

Zip *

Website

Type of Camp *

Resident (overnight)

Day (Non-overnight)

Estimated Number of Residential Camper Days *

(Camper Days = Est. # of campers per day x # days per week x number of weeks per year)

Estimated Number of Day Camper Days *

(Camper Days = Est. # of campers per day x # days per week x number of weeks per year)

Do you want coverage for staff or volunteers? *

Yes

No

Estimated Number of Staff Days?

Estimated Number of Volunteer Days?

(Staff/Volunteer Days = Est. # of staff/volunteers x # days per week x number of weeks per year)

Have you had prior Accident-Medical coverage? *

Yes

No

(If yes, a loss history report will be required prior to the policy being issued.)

Coverage Limits

Accident/Medical Coverage: *

$ 3,500

$ 5,000

$10,000

$25,000

$50,000

(choose at least one)

Sickness Coverage *

no coverage

$ 1,000

$ 3,500

$ 5,000

(choose at least one)

Are any of the following activities provided by the camp?
Check all that apply.

Contact Person *

Email *

Phone *