• Martial Arts School Insurance Questionnaire

  • Applicant is:
  • 4. Light contact?
  • 4a. Full contact?
  • 5. Does the school engage in sparring?
  • 6. Is there any sparring with weapons? (Contact with weapons unacceptable)
  • 8. Any protective gear used?
  • 11. Do students participate in tournaments?
  • 14. Do you require participants/members (or parents of minors) to sign an injury waiver? (Please provide a copy.)
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  • 18. If located in a commercial building, are there any other occupants in this building?
  • 20. Does the applicant own the building?
  • 21. Does the applicant lease any space to other tenants?
  • 23. Are any residential apartments located within this building? (Attach copy of tenant's HO4 & Lease Agreement.)

  • ABUSE & MOLESTATION (If located in Illinois, this section MUST be completed. If located in other states, complete only if you desire coverage.)

  • 1. Does the applicant perform a criminal background investigation, including sexual abuse or child abuse related offenses on prospective employees and volunteers?
  • 2. Does the applicant verify employment-related references?
  • 3. Does the applicant conduct personal interviews?
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  • 5. Does the applicant have knowledge of any incident which could give rise to, or result in, an allegation of sexual abuse?
  • 5. Has there ever been an allegation of sexual abuse made against the insured?

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage?
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  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
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  • COMMERCIAL AUTOMOBILE INSURANCE

  • 1. Does the business title any automobiles or other operating vehicles in the business name?
  • 2. Is insurance coverage needed for owned automobiles?
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  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • COMMERCIAL UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)

  • SIGNATURE

  • The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

  • Questions? 877-244-9090
    Kevin Morency |  kmorency@morencyinsurance.com 

    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://sportsprograminsurance.com/

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