Event Questionnaire

Special Event Program Questionnaire
  • MM slash DD slash YYYY
    • After-Hours Parties (e.g., After Prom, Graduation Night, Retirement) • Amusement Rides, Mechanical Devices, Rock Climbing Walls, Hay Rides / Parade Floats, or Inflatables • Animal Rides • Animal Shows (e.g., Cat, Dog, Horse, Livestock Judging) • Cave Explorations • Fairs • Fireworks or Pyrotechnics • Fishing Derbies • Fraternity or Sorority Parties • Gun Shows/Knife Shows/Shooting Events • Haunted Houses • Motorsports Events (including Demolition Derbies, Mud Bogs, Tractor Pulls, Races, and Stunt Shows) • Overnight Accommodations or Camping Facilities • Overnight Lock-ins • Parades • Political Marches • Political Speeches • Political Rallies • Rodeos • Sporting Events • Water Activities
    The applicant hereby represents and confirms that the information provided, to the best of the applicant’s knowledge, is true and correct and further certifies that applicant has read all of the questions and answers on this application. The applicant understands that incorrect information could void the insurance coverage. The applicant understands that any false or misleading information on this application may be subject to criminal and civil penalties. Any person, who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud. Applicant confirms that he/she has read and understands the individual state fraud notices which are a part of this application for insurance coverage. Applicant acknowledges and understands that any person or persons who knowingly and with intent to defraud any insurance company commits a fraudulent insurance act, which is a crime, is subject to criminal and civil penalties. Fraud Notice THIS NOTICE IS PART OF YOUR INSURANCE APPLICATION.
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