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Aerial Yoga Instructor Form

  • Policyholder Details

  • You are NOT eligible for this coverage if you are under 18)
  • .
  • Policy will become effective on the Requested Effective Date if (a) all required information is provided and (b) the Company has received the initial premium on or before that date. Coverage is issued on an annual basis.
    MM slash DD slash YYYY
  • Risk Management is a method for identifying risks and developing and implementing programs to first, prevent or reduce accidents, injuries or loss and second, to protect the organization. You have agreed to have a Risk Management Plan in place during the coverage period of your policy. If you do not yet have such a plan in place, click here for our Guide to Risk Management. .
  • Waiver Requirement

  • Each INSTRUCTOR must implement a Release and Waiver of Liability and Indemnity Agreement for all students and staff members. Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of an occurrence to a student or staff member. However, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the event of an occurrence to a student or staff member. If No, click here to download a waiver.
  • Please upload any waivers used here. If you can work at multiple locations, and don't have your own individual waiver, please upload each waiver. You can also email them to melanie@anthonyinsuranceservices.com once the application is submitted.
    Drop files here or
    Max. file size: 100 MB.
    • Please describe in detail
    • Please upload copies of training certificates (if any)
      Drop files here or
      Accepted file types: jpg, pdf, png, gif, Max. file size: 1 MB, Max. files: 5.
      • Provide the estimated number of clients you teach/instruct over the course of the year, counting each client/student once.
      • Please describe in detail
      • Please list the various locations you will instructor at . Additional insureds can be added prior to binding coverage.
      • Premium and Coverage Selections

      • $1,000,000.00 Limit Per Occurrence Liability Policy. Please select the general aggregate limit.
      • Aerial Underwriting Questions

        Please answer the questions below as they apply to your aerial instructor operations.
      • the maximum height allowed for aerial activities is 12 feet off the ground. If you go higher than 12 feet off the ground, you will not be eligible for coverage.
      • If you instruct at multiple locations, the safety measures should be listed for each location. You can list the location below and the safety measures below.
      • Provide the annual revenue you make from teaching/instructing.
      • Please describe any type of alcohol related activities with regards to your instruction. If the studio you teach at allows BYOB and/or serves alcohol, please describe below.
      • If you are a renewal client, please note that in the field below and the underwriter will review. If you are a NEW applicant and have had instructor insurance before, please ask your previous or current insurer for your Loss Runs report and they will be able to email it to you. If you are a NEW applicant, and have not had insurance before, please indicate that in the space below.
      • Optional Coverages

      • This liability coverage provides protection for rented, borrowed, hired and other non-owned vehicles driven on studio business. This does NOT cover comp or collision claims. This covers claims arising from bodily injury or property damage (to others) caused by a hired or non-owned vehicle.
      • Liability coverage is provided for claims arising out of alleged sexual abuse and/or molestation.
      • Additional Information

      • Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information in an application for insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. I certify that the above information is true and coverage is not in force until accepted by Anthony Insurance Services, Inc. Coverage is subject to the receipt of payment of the required premium by Anthony Insurance Services, Inc.
      • Authorized Electronic Signature

      • Terms & Conditions

      • I have read and agree with the Terms & Conditions.
      • This field is for validation purposes and should be left unchanged.
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