Urmia Sports Camps Program Application

The Risk Management resources on this site are intended to help answer the following questions. Your host University may also have additional materials and resources available through their Risk Management/EH&S/Legal or other departments.


• 1. Do you have a written safety program for your camp: Yes No
• 2. Do you have a written emergency plan for a weather emergency or other serious emergency: Yes No
• 3. Do you have a custodial parent or guardian sign a liability waiver for every child?: Yes No
• 4. Do you have certified CPR and First Aid Personnel immediately available to your camp?: Yes No
• 5. Are you using the SafeKids Abuse Prevention Plan, or do you have a similar, equivalent plan in place? Yes No
• 6. Have you adopted the Heads-Up Concussion education and prevention program found at the following site and with the following materials or do you have a similar plan in place? Yes No
  Information can be obtained at: http://www.cdc.gov/headsup/index.html
  
  At minimum, review the following documents:
  • Fact sheet for coaches on concussion
  • Fact sheet for athletes on concussion
  • Fact sheet for parents on concussion
  • Clipboard with concussion facts for coaches
• 7. Do you have a Return-to-Play policy that requires any player who has sustained a head injury or who is suspected of having sustained a head injury to:
  • Visit a licensed health care professional for evaluation and clearance, AND
  • Sign (for youth players, have parent/legal guardian sign) a head injury information/awareness sheet before returning to practice or game play.
  Yes No
• 8. Do you give RPS Bollinger permission to send you insurance certificates electronically (via e-mail)? Yes No

CAMP INFORMATION SECTION

1. Select your Sport?
• Press "Control + Click" to select multiple sports.
  Archery Badminton Baseball Basketball Cheerleading Cross Country Educational Camps Fencing Field Hockey Flag Football Non-Contact Football Conditioning Golf Handball Hockey (Non-Checking) Lacrosse Racquetball Rowing Squash Soccer Softball Swimming Tennis Track and Field Volleyball Water Polo Wrestling
  This activity requires individual underwriting in order for coverage to be bound. Please contact one of Bollinger's Sports Underwriters at SportService@RPSins.com or 800-446-5311. Thank you.
• 2. Is your camp being conducted at a university or college? Yes No
• 3. What state do you operate your camp: Select a State AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming
• 4. Do you have off-site activities or trips? Yes No
• 5. Do you have any adult participants (other than staff) at your camp? Yes No