Certificate of Insurance Request
For a Facility your Team is using for training, scrimmages, meetings
Name of Requestor
First Name
Last Name
Your Team & Coach
Your Email
example@example.com
Your Community Club
FULL NAME OF THE FACILITY
*
Address of the Facility
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
NAME of the FACILITY OWNER (sometimes is the same as Name of Facility)
*
Address of the Facility (might be the same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHECK ALL THAT APPLY
*
Outdoor Field Space
Indoor Field Space
Classroom or Event Room
Will be used for Games
Will be used for Training & Scrimmages
Other
Submit
Should be Empty: