Application for Outdoor Learning Programs – Magenta Insurance Professionals

Legal Business Name:(Required)

Mailing Address:

Locaton Address:

Website:

Contact Name:(Required)

Email:(Required)

Phone Number:(Required)

Please provide a full description of all activities, programs, events, and operations:(Required)

How long have you been in business?

Select your type of business:

Are you Licensed?

Do you operate (or plan to operate) year round?

What are your Estimated Annual Revenues (before expenses)?

Number of individual children that attend your program throughout the year (if a child is enrolled multiple times, count that child only once):

Number of Full Time Employees

Number of Part Time Employees

Number of Volunteers

Are there two teachers present at all times?

Please provide credentials of all teachers:

Is the property owner or is it public land?

Do you have an emergency shelter plan, if so please explain:

Do you have access to a building in case of sudden inclement weather?

Is there a body of water?

If yes, please provide further details and what protocols are in place to protect all children in your care:

Are there animals?

If yes, please provide further details including the type(s) of animals and any involvement with the children you care:

Are there overnight events?

If yes, please provide further details:

Do you currently have insurance?

Current Insurer:

Expiry Date:

Please advise if there have been any claims, losses or allocations in the past 5 years:

Are you aware of any situation that may give rise to a claim?

If yes, please provide details:

Name

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