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Insurance
Recreation Nova Scotia: Application for Liability Insurance
Recreation Nova Scotia
Recreation Nova Scotia: Application for Liability Insurance
Organization:
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Mailing Address:
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City:
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Province:
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Postal Code:
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Contact Person:
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Telephone Number (Work):
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Telephone Number (Home):
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Fax Number:
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Email:
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In Operation Since:
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Annual Operating Budget / Revenue:
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Applicant Organization is Provincial / Regional / Other (if Other, please describe):
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Provincial
Regional
Other
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If Other - Specify:
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Non-profit:
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Yes
No
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Describe all activities and sports to be insured:
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Number of Participants:
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Estimated Number of Volunteers:
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Number of Paid Coaches / Managers:
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Number of Volunteer Coaches / Managers:
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Number of Officials / Referees:
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Number of Directors / Board Members:
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Total number of members in association (including participants, coaches, etc.):
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Do you receive & document police checks on all employees, coaches & volunteers:
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Yes
No
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If you do not obtain policy checks, explain:
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Appropriate operational procedures are required to eliminate abuse potential. Do you have a formal written policy including physical, sexual & mental abuse for your employees, coaches & volunteers?
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Yes
No
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Are your employees, coaches & volunteers made aware of the procedures/incident reporting for sexual abuse / harassment?
Yes
No
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Do you have written procedures for handling suggestions or complaints regarding any form of abuse?
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Yes
No
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Describe medical, first aid, safety and security procedures:
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Does the organization rent, lease / maintain a building or property?
Yes
No
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Describe all facilities and properties that the organization uses and / or maintains:
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Describe all facilities and properties that the organization uses and / or maintains, including the nature and frequency of use.
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Does the organization own or use motor vehicles? Describe:
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Does the organization own or use watercraft? Describe:
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Does the organization own any playground equipment?
Yes
No
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If so, describe the equipment and provide full details of the maintenance program in place:
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Does the organization require Board liability insurance? (Directors & Officers Insurance):
Yes
No
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Describe all fundraising activities for which insurance is required (e.g. social events, fundraising activities, other):
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Is alcohol served or available at any of your events?
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Yes
No
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If so, describe those events, specifying dates and name of the liquor permit holder.
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Click Check Box
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