Entertainers' Liability Insurance
Application Form
Contact Information
Name*    
Address*

   
Phone*
Email*
Policy Information
Term
Effective Dates are from the date of application acceptance
and payment through the end of the policy term.
10/1/2018-10/1/2019
Is this a renewal?
Years wearing the red suit?
Have you had any claims filed against you
within the past four years as Santa?*
Estimated number of appearances
Number of Assistants
Member’s Assistant: Mrs. Claus, elf, etc.
Member as Additional Character Endorsement
Member as non-Christmas characters; excluding licensed characters
Coverage Option*
Attention: If you are scheduled/planning to appear as Santa at a Bass Pro facility, please note that they require minimum liability limit of $2 million per occurrence.  In order to comply with Bass Pro's contract, please select coverage option 2.
 
Abuse & Molestation Coverage is excluded unless background checks on member and member assistants are completed and on file.

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 Total
1 Member – Flat/Fully Earned $165.00 $165.00
1 Member – Service Charge $5.75 $5.75
0 Assistant – Flat/Fully Earned $70.00 $0.00
0 Assistant – Service Charge $2.31 $0.00
0 Additional Character Liability $70.00 $0.00
0 Additional Character Liability Service Charge $2.31 $0.00
1 Processing Fee $5.00 $5.00
Total $175.75
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