Certificate of Insurance

Request Form

Please provide the following information to request a Certificate of Insurance. Your request will be submitted to the ACA’s Insurance Brokers for processing. Please allow 3 - 5 business days for processing.

CERTIFICATE HOLDER

Member Organization as registered in the ACA Insurance Program

Member Organization Name

School/Club/Business Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

ADDITIONAL INSURED TO BE ADDED

(i.e. facility owner, property owner, landlord)

Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

OPERATION/EVENT DETAILS

Description of Operation/Event

Location

Include full address, city, province, postal code, and facility name (if applicable)

Start Date

MM

DD

YYYY

End Date

Leave blank if not applicable.

MM

DD

YYYY

CERTIFICATE TO BE SENT TO

If not different than Contact Person listed above.

Name

First Name

Last Name

Email

Questions?

Alberta Cheerleading Association
Percy Page Centre | 11759 Groat Road
Edmonton, AB T5M 3K6
Email: info@albertacheerleading.ca

Certificate of Insurance

Request Form

Questions?

Dedicated to promoting, developing, and regulating cheerleading across Alberta.