Competition Certificate

Requesters Name*

First NameLast Name

Contact Email
Email*

Insured Gyms info*

Gyms Name

Street Address

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Event Date*

Date

YesNo

What is the full name of this event?
*

5-15 yrs only16 and older onlyAll Ages

YesNo

1) IN-HOUSE: At a USAP-insured facility, enrolled students only - FREE2) COMMUNITY OPEN: At a USAP-insured facility, open to participants from your local community, enrolled or non-enrolled, up to 75 competitors or your peak enrollment, whichever is lower - FREE3) LEAGUE: Any event organized, licensed or created by a 3rd Party organization (ex: WN)L, or involving multiple teams from gyms not covered by USAP, or defined as a “Regional”, “National” or International event - Participant insurance fees may apply with a maximum of $5 per competitor or as agreed upon.4) TOURNAMENT: Any event held at an outside facility or venue not covered by USA PARKOUR - $500 fee to underwriter.

YesNoNot sure

YesNo

YesNoNot sure

YesNo

professionallyhomemade

YesNo

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