Amateur Sports / Activities Accident Insurance Quote Request Form (Philadelphia Insurance Companies) Completed Form Examples and Samples
Explore detailed examples and filled samples of the Amateur Sports / Activities Accident Insurance Quote Request Form from Philadelphia Insurance Companies. See how to correctly complete the form for various activities like youth sports leagues, camps, and recreational clubs to ensure you get an accurate quote.
Amateur Sports Accident Insurance Quote Request Form Example - Youth Soccer League
How this form was filled:
This example shows a completed quote request for a youth soccer league seeking accident insurance. It includes details on the organization, the number of players and coaches, the season dates, and the desired coverage limits, such as a $25,000 medical expense benefit with a $250 deductible.
Information used to fill out the document:
- Applicant/Organization Name: Springfield Youth Soccer League
- Mailing Address: 123 Soccer Field Lane, Springfield, IL 62704
- Contact Person: Jane Smith
- Contact Phone: (555) 123-4567
- Contact Email: [email protected]
- Website: www.springfieldyouthsoccer.org
- Requested Policy Effective Date: 08/01/2026
- Description of Activity: Youth recreational and competitive soccer league for boys and girls ages 5-18. Includes practices, games, and regional travel for tournaments.
- Number of Participants (Players): 500
- Number of Staff (Coaches, Volunteers): 50
- Total Number of Persons to be Insured: 550
- Participant Age Range: 5 - 18
- Activity Period / Season: August 1, 2026 - November 30, 2026
- Are there tryouts?: Yes
- Medical Expense Benefit Limit: $25,000
- Deductible Amount: $250 per claim
- Accidental Death & Dismemberment (AD&D): $10,000
- Prior Carrier Information: N/A - New Organization
- Loss History (3 Years): No claims reported.
- Producer/Agency Name: SecureFuture Insurance Agency
- Date Submitted: 06/15/2026
What this filled form sample shows:
- Clear identification of the applicant organization and its primary contact.
- Detailed description of the sporting activity, including participant numbers and age groups.
- Specific coverage period and season dates for the policy, starting August 1, 2026.
- Precise selection of medical benefits and deductible amounts required for the quote.
- Declaration of no prior loss history, which is crucial for underwriting.
Form specifications and details:
| Form Name: | Amateur Sports / Activities Accident Insurance Quote Request Form |
| Insurance Company: | Philadelphia Insurance Companies |
| Use Case: | Youth Soccer League seeking accident insurance for players and staff. |
Created: February 12, 2026 04:28 AM
