Martial Arts Studio General Liability and Property Application (Fitness and Wellness Insurance / Philadelphia Insurance Companies) (03/2011) Completed Form Examples and Samples
View a detailed example of a completed Martial Arts Studio General Liability and Property Application (Fitness and Wellness Insurance / Philadelphia Insurance Companies, form 03/2011). This sample provides a clear guide for dojo owners on how to fill out the form, detailing business operations, liability limits, and property coverage to secure the right insurance.
Martial Arts Studio General Liability and Property Application Example
How this form was filled:
This example shows a completed General Liability and Property Application for a fictional martial arts studio, 'Dragon's Fist Dojo, LLC'. It details business operations, including disciplines taught, student numbers, risk management practices like using waivers, and specifies requested liability and property coverage limits.
Information used to fill out the document:
- Applicant Name: Dragon's Fist Dojo, LLC
- Mailing Address: 123 Dojo Way, Phoenix, AZ 85001
- Contact Person: Kenji Tanaka
- Title: Owner / Head Instructor
- Phone Number: 602-555-1234
- Email Address: [email protected]
- Website: www.dragonsfistdojo.com
- Proposed Policy Period: 05/01/2026 to 05/01/2027
- Years in Business: 10
- Legal Entity: Limited Liability Company (LLC)
- Description of Operations: Martial arts studio offering group and private instruction in Karate and Judo to children (ages 6+) and adults.
- Annual Gross Receipts: $150,000
- Total Square Footage: 2,500 sq ft
- Number of Members/Students: 120
- Number of Instructors (Full-time/Part-time): 1 / 2
- Disciplines Taught: Karate, Judo
- Weapons Training Provided?: No
- Sparring/Contact Allowed?: Yes, with protective gear under supervision.
- Waivers/Hold Harmless Agreements Used?: Yes, required for all members.
- Prior Claims (Last 5 Years)?: No
- General Liability Limit Requested: $1,000,000 Per Occurrence / $2,000,000 General Aggregate
- Business Personal Property Coverage: $50,000
- Applicant Signature: Kenji Tanaka
- Date Signed: 04/10/2026
What this filled form sample shows:
- Provides a clear example for an established LLC martial arts studio.
- Details specific business operations, including disciplines taught and student demographics.
- Confirms use of crucial risk management practices like liability waivers.
- Specifies desired General Liability and Property coverage limits.
- Includes a clean claims history, a key factor for underwriters.
Form specifications and details:
| Use Case: | Established Martial Arts Studio (LLC) applying for liability and property insurance. |
| Form Name: | Martial Arts Studio General Liability and Property Application |
| Insurance Company: | Philadelphia Insurance Companies |
| Form Program: | Fitness and Wellness Insurance |
| Form Version: | 03/2011 |
| Categories: | insurance application forms, insurance forms, Philadelphia Insurance forms, property forms, property insurance forms |
| Created: | February 12, 2026 04:31 AM |