Studio Programs - InsureYourClub.com

Please fill out and submit the application below. Before proceeding, please note:

Are you a member of IHRSA? Yes No

Would you like information on IHRSA? Yes No

Do you offer CrossFit? Yes No

We do not currently offer coverage for CrossFit.

Number of years in business: Prior insurance company:

Other business operations as name insured? Yes No

Please Explain

Have you been cancelled or non-renewed? Yes No

Please Explain

Any liability or property claims last 3 years? Yes No

Please Explain

Provide # of Employees & Independant Contractors:	Full-Time	Part-Time
Personal Trainers:
Fitness/Group Instructors:
Yoga Instructors:
Massage Therapists:
Other:
Totals (from above):

Important! Enter the total number of large pieces of fitness equipment*:
(*EXLUDING: free weights, steps, mats, bands, and balls.)

Check here if you would like to include Property Coverage:

Subject of Insurance	Limits	Deductible	Written w/ 90% Coinsurance, RC Valuation & Special Form Coverage.
Contents and Equipment:	$	$1000	Employee Dishonesty Coverage: Yes No
Tenant Improvements: (If you lease/rent)	$	$1000	Boiler & Machinery Coverage: Yes No
Business Income: (If not sure enter %75% of total revenues)	$	72hr Wait	Business Income max = 12 mo.

All information below must be completed in order to process the application.

Other occupancies in building? Yes No

Please enter other occupancies: (please enter a comma after each occupancy)

Is the building over 25 years old? Yes No

Please enter the last year of update for the following:

Roof: Wiring: Plumbing: Heating:

Right Exposure - Distance: Describe type of business or operation.
Left Exposure - Distance: Describe type of business or operation.
Rear Exposure - Distance: Describe type of business or operation.

Landlords to be added as Additional Interest: (enter name and Address) Leasing Companies to be added as Loss Payee: (enter name and address)

Check to add Hired and Non-Owned Auto:

Check to add Stop Gap Coverage (ONLY IN OH, ND, WA, WV and WY):

Policy Effective Date is upon approval. Or, enter a requested date here:

Word Verification:

Please enter the letters or numbers you see above

Burglar Alarm:	Yes No	Central Station With Keys Alarm installed & serviced by:
Fire Alarm:	Yes No	Central Station Local Gong Alarm installed & serviced by:
Is Building Sprinklered?	Yes No	What % is sprinklered?

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Do you produce videos?	Yes No	#
Are any products manufactured or sold under your label?	Yes No	#
Do you require signed waivers from all clients?	Yes No	#
Do you have defribrillators(s) on premises?	Yes No	#
Is signage used throughout facility to prevent injury?	Yes No	#
Do you sublease any space to others?	Yes No	#
Do you have Automated External Defibrillators (AED)?	Yes No	#