Fill out the below application form to get a free quote on your church insurance.
Does your church have a school?
YesNo
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Date school was founded
Describe security measures taken on premise
Is there a Day Care on site?
Age Group
Infants (0-24 months/2yrs)Toddlers (25-36 months/3yrs)Toddlers (37-48 months/4yrs)Pre-K (49-60 months/5yrs)School Age (61 months & Up)
# of children in each age group
Avg. Daily Attendance
Please fill in the number values for each position if applicable.
Pastors / Ministers
# of Full Time:
# of Part Time:
Custodians
Office Personnel
Tech / A/V Personnel
Counselors
Nurses
Total Number of Church Staff
Total Volunteers for Church
Please fill in the number values for each applicable position.
Administrators
Teachers K5 to 5th
Teachers 6th – 8th
Teachers 9th – 12th
Total Number of School Staff
Total Volunteers for School
Average Adult to Student ratio including helpers
Directors
Teachers 0-24 months
Teachers 25-36 months
Teachers 37-48 months
Teachers 49-60 months
Teachers School Age
Total Number of Daycare Staff
Total Volunteers for Daycare
Do you have a Youth Group ?
Age Range of Children
Number in attendance each week
Who runs the youth group
Student PastorMemberVolunteers
Include a list of activities that are done
List which buildings include the following and provide its age:
Roof
Electrical
Plumbing
Heating & A/C
If not on all buildings please list which buildings:
Do you have a monitored alarm system on all buildings?
BurglarFireLocal(not reporting to any agency)
Do you require a business auto quote with this application ?
*Provide the following for each vehicle:
Year:
Make:
Model:
Vin#
Cost New:
Gross Weight:
Vehicle use:
Garaging location:
How many miles one way:
Provide the following for each approved driver:
Full name:
License #
Date of Birth:
State Licensed:
Type and Year of Commercial driver’s license (if any):
Do you require Workers Comp Quote with this application?
List of Officers names with the following:
Position:
Title:
Job function:
Estimated payroll:
Include or Exclude from the workers comp:
Total number of employees for church not including the officers?
Total number of employees for school not including the officers?
Total number of employees for day care not including the officers?
Employees(Other than officers)
Position tile:
Full or Part time:
Camps?
Music Schools?
Fund Raising?
Dormitories?
Athletics?
Traveling Ministry?
Does the church or its members, volunteers, employees, ministers take part in construction projects?
# of Students
# of Teachers
Your Name*
Your Email*
Fields marked with an * are required
