Application Form

Contact Information
Name*
Address*
Phone*
Email*
Please use the same email address that is on file with your organization as it is used to verify your membership.

Policy Information

Term
Effective Dates are from the date of application acceptance
and payment through the end of the policy term.

Is this a renewal?

Years performing as a Christmas Character?

As a Christmas Character Performer, have you had
any claims filed against you within the past four years?*

Estimated number of appearances from the date
of application through the end of the policy term

Number of Assistants
Member’s Assistant: Mrs. Claus, elf, etc.

Persons other than the member who are assistants

Persons other than the member; Mrs. Claus, elf, etc.

Member as Additional Character
as non-Christmas characters; excluding licensed characters

ADDITIONAL CHARACTER ENDORSEMENT INCLUDES BUT IS NOT LIMITED TO: Clowns; Uncle Sam; Easter Bunny;
Renaissance Fairs; Magicians; Story Tellers
EXCLUSION FOR USE OF LICENSED CHARACTERS WITHOUT THE WRITTEN PERMISSION OF THE LICENSOR ADDED.
Example: Mickey Mouse; Sponge Bob Square Pants; Marvel Super Heroes; DC Super Heroes; Teenage Mutant Ninja Turtles

Member as Character/Entertainer
as non-Santa characters; excluding licensed characters

Yes

Include Property Coverage*

Property endorsement covers props and costumes against direct physical loss up to [PropertyPropsAndCostumes]. Exclusions apply. A per claim deductible applies.

Property endorsement covers props and costumes against direct physical loss up to [PropertyPropsAndCostumes] and resulting loss of income up to [BusinessIncome]. Exclusions apply. A per claim deductible applies.

Yes

Coverage Option*

Form Messages

Applicant's Statement and Declarations

The applicant declares to the best of his/her knowledge the information contained in this application and all supplements attached to be true and that no material facts have been suppressed or misstated. The applicant further understands that any false or fraudulent statements or misrepresentations could result in the termination of voidance of any insurance contract issued from the information stated herein.

Payment Information

Quantity	Description	Rate
1	Member – Flat/Fully Earned
1	Member – Service Charge
	Assistant – Flat/Fully Earned
	Assistant – Service Charge
	Property Coverage
	Property Coverage - Service Charge
	Additional Character Liability
	Additional Character Liability Service Charge
1	Processing Fee
		Total