Martial Arts Quote Form

Martial Arts Schools & Programs - Eligibility

Please select the style(s) of martial arts offered at your facility (select all that apply).

Aikido
Brazilian jiu jitsu
Capoeira
Chi kun
Fitness boxing(non-contact)
Goju-ryu
Hapkido
Jeet kune do
Judo
Juijitsu
Karate *
Kenjitsu
Kickboxing (cardio/fitness only)
Kickboxing (contact/sparring)
Krav maga
Kung fu
Shaolinquan
Taekwondo
Tai chi
Taijiquan
Tang soo do
Wushu

Note - Karate includes various styles such as: Chito-ryu, Goju-ryu Isshin-ryu, Shuri-ryu, Kyokushinkai, Seido juku, Keichu do, Keichu-ryu, Shorin-ryn, Shotokan, Shito-ryu, Uechi-ryu, Wado-ryu and Yoshukai karate.

If the styles of martial arts are not listed above, DO NOT CONTINUE. Please contact our office at 1-877-917-6056.

Desired effective date

In what state is the insured’s business mailing address?

Is the current carrier non-renewing coverage?

Yes
No

Have any liability claims been paid under the facility’s insurance coverage in the last three years?

Yes
No

Does the facility have climbing walls?

Yes
No

Martial Arts Schools & Programs- Ineligible Operations

The following are ineligible for enrollment in this program and coverage is excluded. To continue this process online, you must first confirm that none are offered at the facility obtaining a quote.

-Boxing (contact/sparring) -Sayoc kali -Dim kam -Thai boxing/muay thai -Haganah -Training programs for law enforcement, public safety and military personnel -Kali/escrima -Ultimate fighting/extreme fighting/cage fighting -Mixed martial arts* -Wrestling -Savate

*Mixed martial arts is defined as a full contact sport that allows a wide variety of fighting techniques from a mixture of martial arts traditions. This includes styles such as ultimate fighting, extreme fighting and cage fighting.

Do any of the above apply to this facility?

Yes
No

Martial Arts Schools & Programs - Rating

Martial Arts School Operations:

*Estimate the number of martial arts participants that will be enrolled in your program at your busiest time of the year

Coverage does not extend to subsidiary activities offered by the insured unless they are reported.

Subsidiary activities are those that:

- Not part of the normal martial arts instruction operations - Are available to non-registered participants of the school - Require members to pay a separate registration or enrollment fee to participate

Subsidiary Activities

Estimate the total number of non-registered or separately enrolled participants in each of the following activities, if any:

Yoga and/or exercise classes:

Basketball and/or volleyball:

Theater arts:

Meetings and/or seminars:

Birthday Parties:

Estimate the number of birthday parties expected to take place during the requested coverage period, if any:

Optional Coverages - Hosted Tournament

This optional coverage extends liability protection for hosted tournaments organized and operated by the insured that include participants who are not members of the martial arts school.

Is hosted tournament coverage needed for tournaments organized by the insured that include participants who are not members of the martial arts school?

Yes (please fill out tournament info below)
No

Please provide the following information for your hosted tournament:

Event name:

Location name:

Event date(s):

Event hours (times):

Total outside participants (non-members):

Optional Coverages - Abuse, Molestation, Harassment or Sexual Conduct Defense Cost Reimbursement

The coverage reimburses you up to $100,000 per claim / $100,000 aggregate for defense costs from claims.

Do you want to add this coverage to this quote?

Yes (please answer the questions below)
No

Are all prospective employees required to complete a written employment application?

Yes
No

Does your employment application ask the applicant if they have ever been convicted of a crime?

Yes
No

Are references obtained and checked prior to hiring a staff member?

Yes
No

Do you have frequent discussions with your staff on the importance of providing a safe environment for the children in your care?

Yes
No

Do you have written procedures for responding to a reported abuse incident?

Yes
No

Is a copy of the written procedure provided to each member of your staff?

Yes
No

Is mandatory notification to local law enforcement included in your written procedures?

Yes
No

Is suspension of the accused employee part of your written procedures?

Yes
No

Has any member of your organization ever been involved in an incident which resulted in an allegation of abuse or molestation?

Yes
No

Number of facility locations:

Optional Coverages - Equipment & Contents (Inland Marine)

This provides coverage for direct loss or damage to your supplies and equipment, furnishings, improvements and betterments, signs and nonstructural glass due to fire, theft, vandalism or other covered causes (subject to actual policy terms and conditions).

Does the insured have leased/owned equipment that they want to insure?

Yes (please complete below info)
No

Replacement cost value amount: $

Insured Information

*Named insured (as it should appear on the policy)

Doing business as (DBA)

*Contact first name:

*Contact last name:

*Mailing address:

Address Line 2

*City:

*State

*Zip:

*Phone (including area code):

Fax (including area code):

*E-mail:

*Re-confirm e-mail: