Certificate of Insurance Request

If you have any questions regarding this form or Certificates of Insurance, please contact 456certinsurancerequest@scouting.org.

Your Name:*

First and Last Name

Your phone number:*

Just in case we have questions about your request!

Your Email Address*

Name of activity/event you need covered:*

e.g., Troop 93's Spring Campout or Arrowhead District Camporee

Event Address:*

Where will the event be held?

Unit Number or District Name:*

Please enter your unit number for unit-level events or your district name for district-level events.

Activity/Event Start Date:*

Activity/Event End Date:*

Name of organization/company:*

The organization/company that is requesting the coverage

Address of organization/company:*

The organization/company that is requesting the coverage

Requesting Organization Requirements

If the organization provided you with specific requirements for the COI, please attach the document here.

Drag and drop files here or

Other Information

Please enter any other pertinent information here.

Send me a copy of my responses