Summit America Insurance Services

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Please note our address has changed! Our new address is: PO Box 25936 Overland Park, KS 66225. The new address is available at the bottom of the page.

Colleges & Universities

Students & Participants

Liability Programs

Forms and Applications

Liability Programs

Coaches' Choice	Facilities
Sports Camps and Clinics Sports Instructors Teams and Leagues Tournaments and Events Amateur Sports Adult Soccer Teams, Leagues, Clubs and/or Associations	Sure Step Dance Schools The Defender Martial Arts Programs Tumble Time Gymnastics Programs
Exercise & Fitness	Events & Other
Dance Instructors Fitness Instructors Exercise/Circuit/Personal Training Studio Programs Health Club - Limited Services Programs The Defender Martial Arts Instructors	Activity & Social Club Concessionaires Exhibitors & Vendors Entertainer & Performer Programs Short-Term Special Events Youth Day Camps Independent Instructor Event Planner Bands & Performing Groups

Coaches' Choice: Sports Camps and Clinics Top

Brochure & Application (155K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Coaches' Choice: Teams and Leagues Top

Brochure & Application (194K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

	Teams and Leagues Supplemental Applications:
	Directors & Officers (245K PDF) Hosted Tournament (68K PDF)

	Amateur Sports Adult Soccer Teams, Leagues, Clubs and/or Associations:
	Brochure & Application

Coaches' Choice: Tournaments and Events Top

Brochure & Application(147K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Coaches' Choice: Sports Instructor Insurance Program Top

Brochure & Application (177K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Coaches' Choice: Sports Instructor Insurance Program Top

Brochure & Application (177K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Youth Day Camps Insurance Program Top

Brochure & Application (177K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Concessionaires Exhibitors & Vendors Insurance Program Top

Brochure & Application (174K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Activity & Social Club Insurance Program Top

Brochure & Application (283K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Short-Term Special Events Insurance Program Top

Brochure & Application (177K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Dance Instructor Insurance Program Top

Brochure & Application (164K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Sure Step Dance School Insurance Program Top

Brochure & Application (205K PDF )*
Supplemental Request Form (110K PDF )*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*
Supplemental Workers' Compensation (68K PDF)*

The Defender Martial Arts Insurance Program Top

Brochure & Application (211K PDF )*
Supplemental Request Form (110K PDF)*
Martial Arts Instructor Program (154K PDF)*
Hosted Tournament (110K PDF)*
Claim Form (168K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Tumble Time Gymnastics Top

Application Form (105K PDF)*
Benefits Brochure (212K PDF)*
Gymnastics Claim Form – Nationwide Mutual (71K PDF)*
Gymnastics Claim Form – National Union Fire (168K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)

Entertainer & Performer Insurance Program Top

Brochure & Application (290K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Exercise/Circuit/Personal Training Studio Insurance Program Top

Brochure & Application (178K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Health Club - Limited Services Insurance Program Top

Brochure & Application (176K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Independent Instructor Insurance Program Top

Brochure & Application (261K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Event Planner Insurance Program Top

Brochure & Application (284K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

Bands & Performing Groups Insurance Program Top

Brochure & Application (299K PDF)*
Medical Claim Form (71K PDF)*
Liability Incident Notification Form (23K PDF)*
Authorization to Release Information (24K PDF)*

* PDFs require Adobe Reader v.6.0 or later.
(Enterable PDF forms can be filled out electronically.
Data entered electronically CANNOT be saved.
To keep a copy, please print your completed form.)

Summit America Insurance \| info@summitamerica-ins.com		Copyright 2007 Summit America Insurance Services
Overland Park Office PO Box 25936 Overland Park, KS 66225 1-800-955-1991	Salt Lake City Office 2180 South 1300 East, Suite 520, Salt Lake City, UT 84106 1-800-955-1991 ext. 198	All Rights Reserved. Terms of use