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Company Info
General Info
Abuse
Fraud Page
Confirmation
Section 2: GENERAL INFORMATION
Are you a single performer or part of a group?
Single
Group
Single Performers
Type of entertainer/performer (check all that apply):
Actor portraying historical person (actual/fictional)
Balloon Artist
Belly Dancer
Caricature Sketching
Celebrity look-alike
Clown
Comedian
Conductor
Contortionist
DJ/KJ
Face/body painter
Holiday character
Impersonator
Impressionist
Juggler
Magician
Mime
Musician, singer or vocalist - Genre of music & % of each
Poet
Puppeteer
Story teller
Ventriloquist
Western performer
Yodeler
Other (subject to approval)
Your Annual Gross Revenue:
Are you age 18 or older?
Do you own or operate your own facility?
If yes, this program only provides coverage for your operations as an entertainer/performer. It does not extend to your employees or anyone assisting or performing on your behalf, nor does it apply to the operation of a facility.
Do you conduct/perform operations outside of the U.S.?
If yes,how many times per year do you perform outside the U.S.?
If yes, what is the maximum number of consecutive days you will spend outside the U.S. for performances?
Do your performances/operations include any of the following:
Yes
No
Amusement devices, Animals*, Athletic activity, Body surfing or mosh pits, circus act, fire (fire-works,pyrotechnics), Full body art/painting, Haunted attractions, Historical battle reenactments, Hot was impressions, Hot wax impressions, Hypnotism, Stunts and/or strength acts, Permanent tattooing or body piercing, use of any substance to paint or apply on the face or body that is not classified as non-toxix and/or manufactured using only FDA compliant ingredients, Weapons (live ammunition/sharpened blased) Note: the exposures/activities listed above are not covered by this program and any resulting claims will be denied. *Limited Small Animal Coverage Available
Group Performers
Type of entertainer/performer (check all that apply):
Balloon Artists
Band
Belly Dancer
Bugle Corp (Instrumental)
Caricature Sketching Artists
Celebrity Look-alikes
Choral Group
Clowns
Comedians
Contortionists
DJ’s or KJ’s
Drum Corp
Face/body Painters
Holiday Characters
Impersonators
Impressionists
Jugglers
Magicians
Mimes
Musical Ensemble (quartet,duo, instrumental)
Poets
Puppeteers
Storytellers
Ventriloquists
Western Performers
Yodelers
Other (subject to approval)
If applicable, the type of music genres performed and the % of each (check all that apply):
Big Band
%
Bluegrass
%
Blues
%
Classical
%
Country
%
Ethnic/World
%
Folk
%
Jazz
%
Oldies
%
Pop/Soft Rock
%
R&B
%
Religious/Gospel
%
Swing
%
Other (describe)
%
Type of venues where group performs and the % at each (check all that apply):
Auditoriums
%
Bars
%
Nightclubs
%
Outdoor venues
%
Reception halls
%
Schools/Universities
%
Other (describe)
%
Do you own or operate your own facility?
Yes
No
(If yes, this program only provides coverage for your operations as a band or performing group.)
Are any of the events where the group performs part of a promoted tour?
Yes
No
Annual Gross Revenue:
What is the maximum daily attendance at any one performance?
Do you have more than 30 members in the performing group?
Yes
No
Is at least one member or representative of the group 18 or older?
Yes
No
Do you conduct/perform operations outside the US?
Yes
No
If yes, How many times per year do you perform outside the U.S.?
If yes, What is the maximum number of days you will spend outside the U.S. for performances?
Do your performances/operations include any of the following:
Yes
No
• Animals • Athletic activity • Body surfing/mosh pits • Circus act • Fireworks/pyrotechnics • Full body art/painting • Hot wax impressions • Hypnotism • Stunts and/or strength acts • Throwing of object(s) into the audience during a performance • Weapons (live ammunition/sharpened blades) • Use of non-FDA approved/compliant products • Permanent tattoos or body piercing • 2,500 or more in attendance
Note: The exposures/activities listed above are not covered by this program and any resulting claims will be denied
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