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CERTIFICATE REQUEST SHEET


Note:  If riskier activities, we may need additional information such as:  Swimming activity involving minors – will there be a life guard present and who is providing the life guard, camp or church? Or if a climbing wall, who is supervising – camp staff or church staff, ect.



FULL ARMOR CLIENT INFORMATION
Church / Organization Name
Required
First Name
Required
Last Name
Required
City
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State
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ZIP / Postal Code
Required
E-Mail Address
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Your Contact Phone #
Required
Date Certificate Needed By
Required
/ /
ACTIVITY / EVENT INFORMATION REQUIRING CERTIFICATE
Activity Name or Description:
Required
Dates Of Activity/Event:
Optional
Location of activity (Include Address)
Required
Aprox # Attendance:
Required
Age range of Participant if Youth event
Required
Summary list of activities
Required
Is Church providing Transportation?
Required

Is Church providing food?
Required

Are Permission Slips/Waiver-Hold Harmless retained:
Required

CERTIFICATE HOLDER INFORMATION
Entity Name/Address requesting Certificate from you:
Required
Did they request Additional Insured Status:
Required

Email or fax number to send Cert:
Required
Additional Information or Comments
Optional
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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