Accident Insurance for Campus Events
Completion of this form is not a guarantee of coverage. Events must meet all requirements outlined by the insurance policy. If you have any questions or would like to discuss program coverage please contact the Office of Risk Management.
LSUHSC New Orleans
LSU Registered Student Organization
University Lab School
Type of Event
Festival and Cultural Events
Meeting and Lectures
Plays or Theatrical Stage Performances
Sporting/Fitness Events or Competitions
Summer Camp (Non-Sport)
Summer Camp (Sport)
Other (Please Describe)
Event Start Date
Event End Date
Number of LSU Students Participating
Will non-LSU Students (any other person) be participating in your event?
Number of Non-LSU Students Participating
Please only enter a value greater than 0 if the person(s) participating are not an LSU student or LSU Employee. No other text characters are needed.
If coverage is being provided to anyone other than LSU Students please include an account number that will be billed at ten cents per person per day at the end of each semester. If Account is grant funded, please respond to your confirmation e-mail with the date that all charges should be processed.
Will Participants be traveling Off-Campus
Primary Contact Person
Primary Contact E-mail
Primary Contact Phone #
Send me a copy of my responses
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