Certificate of Insurance Request

Certificate of Insurance Request

Property owners (schools, churches, municipalities, businesses) hosting Girl Scouts River Valleys events often require proof of insurance in the form of a Certificate of Insurance.
Before completing form, confirm with the property owner whether they already have our current Certificate of Insurance (COI) on file. If not, proceed with the request form.

Use the below form to request a Certificate of Insurance. Please allow at least three business days for a request to be processed. The completed certificate will be emailed to you, the requester, as well as the property owner email address you list on the form.

Girl Scouts River Valleys Certificates of Insurance renew on October 1 each year. Any properties that received a Certificates of Insurance the previous year will automatically receive the renewal certificate near the expiration date. If not received by October 5, please submit this request form.
Girl Scouts River Valleys Volunteer Information
Name*

First NameLast Name
Email*
example@example.com
Type of Event*
Property Owner Requesting Certificate of Insurance
Business Name*
Business Contact Email Address*
example@example.com
Business Contact Fax
Please enter a valid phone number.
Business Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Comments
Should be Empty:

Girl Scouts River Valleys Volunteer Information