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Event Listing

Liability Application

This application must be completed and signed by each user that requires insurance coverage. Please note that payment must be made to the Parish or School before coverage can be bound.

Parish Info

Parish(Required)

Your Email(Required)

Your Name(Required)

First Last

Individual or Group Info

Name of Individual or Group User(Required)

Name of Contact(Required)

Mailing Address(Required)

Street Address Address Line 2 City Province Postal Code

Contact Phone (Business)(Required)

Contact Phone (Home)(Required)

Payment Method(Required)

Cash

Cheque

Credit Card

Type of Event

Estimated Number of Attendees(Required)

Will alcohol be served?(Required)

Yes

No

Premium ($) for Event(Required)

Is this for a single event or multi-day/seasonal?(Required)

Single Event

Multi-Day/Seasonal

Single Event Info

Date of Event(Required)

MM slash DD slash YYYY

Event Details(Required)

Multi-Day/Seasonal Event Info

"From" Date(Required)

MM slash DD slash YYYY

"To" Date(Required)

MM slash DD slash YYYY

How often does the group meet?(Required)

Weekly

Monthly

Other

How often does the group meet (other)(Required)

Group Activity Details(Required)

Signature & Date

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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