Girl Scouts of the U.S.A. Claim Form

Certificate of Liability Insurance Request Form

To receive a Certificate of Liability Insurance please complete the required fields below.

Request needs a minimum of three (3) business days for processing.

Requestor's Name*

First NameLast Name

Requestor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Volunteer's E-mail*

Volunteer's Phone Number*

Area CodePhone Number

I consent to receive SMS from Girl Scouts of North East Ohio. Reply STOP to opt-out; Reply HELP; Message and data rates apply; Messaging frequency may vary."

By checking this box, I consent to receive customer care and account notification text messages (SMS or MMS) from Girl Scouts of North East Ohio. You may opt-out at any time by replying STOP. For assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).

Date of Activity/Event*

Business/School District Name and email address:*

Business/School District Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code