KarateInsurance.com

Please complete the following application and submit to bind coverage. If you have any questions, please email or call 888-868-1164/970-390-7860.

Complete if you are in the following states: Alabama, Colorado, Connecticut, Maryland, Massachusetts, Minnesota,
New Hampshire, New York, North Carolina, Vermont, Washington.  If in a different state, please click here.

School Information

Name of School:

 School Owner(s):

   

Do you receive mail at your school?, If not, please complete the following.
School Address: Mailing Address:
City: City:

State:

State:

Zip:

Zip:
  Include additional locations below.      

Phone #:

Email Address:
Cell Phone:

Website:
         
Premium Calculation:
 		 Premium is based on number of students. The rate is $8.95 per student with a $450 minimum premium.  If you have 50 students or less, you are at the minimum premium.  The minimum premium is fully earned by the insurance company.  This means if you cancel your insurance before it expires, there is no return premium.
Number of Students:

Where did  you hear about us?

Tournament Coverage - Are you hosting a tournament, camp or seminar in the near future that you would like add to your policy now?  The charge is $100 for 200 or less participants. If more than 200 participants, please call or email. Only for traditional Martial Arts Tournaments.  If you are hosting MMA or Kickboxing, please give us a call.
 
Please add this coverage (check here)                    Date of Tournament, Camp or Seminar    # of Participants    # of Spectators
 

What Style do you teach?  Please be specific.

Has any prior coverage been cancelled or non renewed? If Yes check here and please explain below. Otherwise enter "no"

Have you had a liability loss in the past 3 years? If Yes check here and please give the details below. Otherwise, enter "no"

Are you an insurance agent submitting this application for your client?  If so, please enter your name, phone number and email address.

   
Does your organization currently utilize a waiver system?     Yes     No   If you need a copy of the waiver please click here
   

Type of Business: 

 

  

Additional Insureds

Complete this section if you need to provide evidence of insurance to a landlord, gym, municipality, school or others. If you have more than 4 additional insured's, please contact us. 
 
  Location Location Location Location
Certificate Holder:
Mailing Address:
City:
State:
Zip:
Relation to insured:
         

Location Information - If you have additional locations, please include here.

  Location #2 Location #3 Location #4 Location #5
Street Address:
City:
State:
Zip:
         
         

Property Coverage - Contents (optional) - Coverage on your personal property you own (mats, weights, inventory and equipment). Once you submit your application, you will be given an option for a property quote.

Payment Information

The soonest we can bind your insurance is the day following receipt of payment.  If you pay with a credit card, we can bind as early as tomorrow.  If you mail us a check, coverage will be bound the day after we receive it. Currently only accepting American Express, Visa, Discover and MasterCard.

What date would you like coverage to start?  

  (mm/dd/yyyy) Leave blank if paying by check

How would you like to pay for your new insurance?  

 
   
We keep the costs down for this program by doing as much by internet and email.  If you do not have an email address and want your policy mailed, there is an additional charge of $10.00 to cover postage and handling.  Policy Deliver Method: 
  Send policies to the above email address
 Send policies the above mailing address. I understand and additional $10.00 will be added to my premium.

 

        

Secure Credit Card Payment
 

Card Type

     

Name as it appears on card:

Card Number:

   XXXX-XXXX-XXXX-XXXX

Card Expiration Date:

 (MM/YY)  
 

CVS #:

 If you are not sure where to find the CVS #, Click Here
 

 
 
Each school or studio must install a Release and Waiver of Liability and indemnity Agreement for all students and staff members.  Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of any occurrence to a student or staff member.  However, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the event of an occurrence to a student or staff member.  A Waiver/Release form will be emailed to your school or studio upon request. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer submits application or files claim containing a false or deceptive statement may be guilty of insurance fraud.  The minimum premium on this program is also the minimum earned.  What this means is if you cancel your insurance, the insurance company will keep the minimum premium and not return any premium to you.  Any premium above the minimum will be returned on a prorate basis if cancelled.

Check that you have read the above statement

Once you hit the submit button, all your information will be transferred electronically.  The following page will be confirmation of payment and evidence of insurance for certificate holders. You should print this page for your records.  Your insurance policies, be emailed to you within a couple of days in Adobe/PDF format.