Martial Arts Program Form - BrokerForce Insurance

For all your Martial Arts insurance needs including; Boxing, Kung Fu, Karate, MMA, Muay Thai, Brazilian Jiu Jitsu, Kickboxing, Tae Kwon Do, Judo, Krav Maga & more!

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Please provide your details below, and one of our experienced Martial Arts Insurance team members will reach out to assist you.

How did you hear about BrokerForce Insurance?

i.e. Google Search, Social Media, Referral (please let us know who referred you), etc.

What type of Martial Arts Insurance are you looking for?

What date is the quote required for?

If not required by a certain date, leave blank.

Contact Name:*

First Name Last Name

Academy/Club Legal Name:

Position:

How would you like us to Contact you?*

Phone

Email and Phone call are fine

Email:*

Business Phone:*

Cell Number:*

Club Mailing Address:*

Address City Province Postal Code

Website:

Provide more info

Is your academy affiliated with any provincial or national organization?*

Yes

Please list:*

How many years have you been in business:*

Are you a new venture?

Yes

Current policy expiry/requested new policy effective date:*

Liability limit required*

Is Sport Accident coverage required?*

Yes

Is Legal Assist coverage required?*

Yes

Has the club ever been cancelled or non-renewed by an insurance company?*

Yes

Please explain:*

Any liability, injury, or property losses/claims in the past five years?*

Yes

Please list:*

Martial Arts Disciplines practiced: (Select all that apply)

If selected 'Other' please specify?

Any other activities? (eg: Fitness, Yoga, Zumba, etc.):*

Yes

Please list:*

Annual Gross Receipts:*

How many locations do you operate?*

Total number of active club participants? (Including all classes, day camps, and after-school programs):*

Is a liability waiver/release for signed by each participant?:*

Yes

Do any students participate in sparring? (ie: striking)*

Yes

Is full protective equipment worn? (head, mouth, groin, hand, leg)*

Yes

Are any weapons used?*

Yes

Please describe (type, used for kata, technique, or sparring?)*

Total number of instructors:*

Are all coaches/instructors certified?*

Yes

Any off premises activities?*

Yes

Please describe*

Any activities/events outside of Canada?*

Yes

Please describe*

Do you offer food or beverage services?*

Yes

Snacks/Drink bar*

Yes

Vending Machines*

Yes

Please describe food service operations (items offered, staffed or unsupervised, approx annual sales)*

Any children's after school programs?*

Yes

How many NON-MEMBER participants are expected?*

Details*

Any children's birthday parties?*

Yes

Approximately how many parties per year?*

Any day camps? (eg: P.A. days, March Break, Summer etc.)*

Yes

How many NON-MEMBER participants are expected?*

Details:*

Tournaments

Do you ATTEND any tournaments?*

Yes

List how many and the number of your members attending each:*

Do you HOST any tournaments?*

Yes

List how many and the number of participants and spectators attending each:*

Is participant liability covered by a sanctioning body?*

Yes

No, coverage is required

Seminars

Do you ATTEND any seminars?*

Yes

List how many and the number of your members attending each*

Do you HOST any seminars?*

Yes

List how many, whether on or off site, and the number of NON-MEMBER participants attending each:*

Events

Do you ATTEND any events? (eg: Social, Fundraising, Terry Fox run, etc.)*

Yes

List and describe each event and specify the number of your members attending each:*

Do any events involve alcohol?*

Yes

Describe:*

Location #1 - Property Information

Club Location Address 1:*

Street Address City Province Postal Code

Years at this location (Location #1):*

Do you own or lease the building? (Location #1):*

Owned

Leased

Number of Employees (Location #1):*

Area you occupy - Square Footage (sq ft) (Location #1):*

Combines value of: building (if owned), Contests, Unit Improvements, and Equipment 1:*

Building age/year built (Location #1):*

Number of stories (Location #1):*

Fire Protection (Location #1):*

Additional details (Location #1):

Additional Locations

Add location 2

Location #2 - Property Information

Club Location Address (Location #2):*

Street Address City Province Postal Code

Years at this location (Location #2):*

Do you own or lease the building? (Location #2):*

Owned

Leased

Number of Employees (Location #2):*

Area you occupy - Square Footage (sq ft) (Location #2):*

Combines value of: building (if owned), Contests, Unit Improvements, and Equipment (Location #2):*

Building age/year built (Location #2):*

Number of stories (Location #2):*

Fire Protection (Location #2):*

Additional details (Location #2):

Add location 3

Location #3 - Property Information

Club Location Address (Location #3):*

Street Address City Province Postal Code

Years at this location (Location #3):*

Do you own or lease the building? (Location #3):*

Owned

Leased

Number of Employees (Location #3):*

Area you occupy - Square Footage (sq ft) (Location #3):*

Combines value of: building (if owned), Contests, Unit Improvements, and Equipment (Location #3):*

Building age/year built (Location #3):*

Number of stories (Location #3):*

Fire Protection (Location #3):*

Additional details (Location #3):

Add location 4

Location #4 - Property Information

Club Location Address (Location #4):*

Street Address City Province Postal Code

Years at this location (Location #4):*

Do you own or lease the building? (Location #4):*

Owned

Leased

Number of Employees (Location #4):*

Area you occupy - Square Footage (sq ft) (Location #4):*

Combines value of: building (if owned), Contests, Unit Improvements, and Equipment (Location #4):*

Building age/year built (Location #4):*

Number of stories (Location #4):*

Fire Protection (Location #4):*

Additional details (Location #4):