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(813) 689-8878
Church Insurance Application
Fearnow
2022-11-03T14:13:17-04:00
Church Insurance Application
Fill out the below application form to get a free quote on your church insurance.
Form Submission is restricted
Form is successfully submitted. Thank you!
Church Info
Number of members
Average weekly attendance
Year's experience of Pastor
Seating capacity of main sanctuary
Annual gross receipts (Tithes / Offerings)
Percentage of total gross receipts from online giving
School Info
Does your church have a school?
Yes
No
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?
Yes
No
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Age Groups
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 group
Average Daily Attendance
Total Staff Breakdown
Church Staff Details. Please fill in the number values for each position if applicable.
Pastors / Ministers - # of Full Time:
Pastors / Ministers - # of Part Time:
Custodians - # of Full Time:
Custodians - # of Part Time:
Office Personnel - # of Full Time:
Office Personnel - # of Part Time:
Tech / A/V Personnel - # of Full Time:
Tech / A/V Personnel - # of Part Time:
Counselors - # of Full Time:
Counselors - # of Part Time:
Nurses - # of Full Time:
Nurses - # of Part Time:
Total Number of Church Staff
Total Volunteers for Church
School Staff
Do you have a school staff?
Yes
No
Note: If you selected 'No' to the above answer, you can skip this section of the application.
School Staff Details
Please fill in the number values for each applicable position.
Administrators - # of Full Time:
Administrators - # of Part Time:
Nurses - # of Full Time:
Nurses - # of Part Time:
Teachers (K5 to 5th) - # of Full Time:
Teachers (K5 to 5th) - # of Part Time:
Teachers (6th - 8th) - # of Full Time:
Teachers (6th - 8th) - # of Part Time:
Teachers (9th - 12th) - # of Full Time:
Teachers (9th - 12th) - # of Part Time:
Counselors - # of Full Time:
Counselors - # of Part Time:
Total Number of School Staff
Total Volunteers for School
Average Adult to Student ratio including helpers
Day Care Staff
Do you have a daycare staff?
Yes
No
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Day Care Staff Details
Please fill in the number values for each applicable position.
Directors
Nurses
Office Personnel
# of Full Time:
# of Full Time:
# of Full Time:
# of Part Time:
# of Part Time:
# of Part Time:
Teachers 0-24 months
Teachers 25-36 months
Teachers 37-48 months
# of Full Time:
# of Full Time:
# of Full Time:
# of Part Time:
# of Part Time:
# of Part Time:
Teachers 49-60 months
# of Full Time:
# of Part Time:
Teachers School Age
# of Full Time:
# of Part Time:
Total Number of Daycare Staff
Total Volunteers for Daycare
Youth Group
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Age Range of Children
Number in attendance each week
Who runs the youth group
Please select
Please select
Student Pastor
Member
Volunteers
Include a list of activities that are done
Property Info
Buildings
List which buildings include the following and provide its age in years:
Single Line
Single Line
Single Line
Single Line
If not on all buildings please list which buildings:
Do you have a monitored alarm system on all buildings?
Burglar
Fire
Local (Not reporting to any agency)
Business Auto Info
Do you require a business auto quote with this application ?
Yes
No
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Owned Autos
Provide the following for each vehicle:
Year
Make
Model
VIN#
Cost New
Gross Weight
Vehicle Use
Garaging Location
How many miles one way
Driver Information
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):
Workers' Comp Info
Do you require Workers Comp Quote with this application?
Yes
No
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Directors & Officers
List of Officer's 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)
Title
Full or Part time
Job function
Estimated payroll
Note: If you selected 'No' to the above answer, you can skip this section of the application.
Directors & Officers
List of Officer's 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)
Title
Full or Part time
Job function
Estimated payroll
Other Info: Does Any Of The Following Apply
Camps?
Please select
Please select
Yes
No
Music Schools?
Please select
Please select
Yes
No
Fund Raising?
Please select
Please select
Yes
No
Dormitories?
Please select
Please select
Yes
No
Athletics?
Please select
Please select
Yes
No
Traveling Ministry?
Please select
Please select
Yes
No
Does the church or its members, volunteers, employees, ministers take part in construction projects?
Please select
Please select
Yes
No
Private Education Info
Private Elementary School
# of Students
# of Teachers
Contact Info
Name
*
Email
*
Submit
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