Information

You will need to provide the following breakdown of who is being covered.

• Total Adults (18 years old on July 1)

• Total Minors

• List of Teams (include names, divisions and levels)

You will also need to further sort all persons insured into one of the following groups (description below), in relation to your program:

1. Coaches/Trainers/Instructors

   • Members teaching, training, and developing teams and athletes in your program; holds a valid certification.

2. Coaches in Training (CIT)

   • Members performing and/or assisting with coaching duties, supervised by a Certified Coach, while not certified or working towards certification.

3. Athletes

   • Members participating in competitive or recreational programs, competitions, and other activities approved by the ACA.

4. Athlete-Coaches

   • Members who are a Coach/Trainer/Instructor and an Athlete at your program.

5. Athlete-CITs

   • Members performing and/or assisting with coaching duties, supervised by a Certified Coach, while not certified or working towards certification AND actively participating as an athlete in competitive or recreational programs, competitions, and other activities approved by the ACA.

6. Support Personnel

   • Members that do not fit into any of the categories above but need to be insured.

     • E.g. Gym Owners/Managers, Admins/Coordinators, Staff Advisors, etc.

Note: Individuals should be subcategorized based on their role at your program only. Any roles held outside your program do not need to be considered for this form.