Trainer/Instructor Quick Quote

Are you an insurance agent or broker?*

Yes
No

Name*

First Last

Mailing Address*

Street Address City State ZIP Code

Phone

Email*

Website Address*

If not applicable type "none"

Association Membership*

Yes
No

If so please check all that apply

(CHA) Certified Horsemanship Association
(PATH) Professional Association of Therapeutic Horsemanship
Other
None

If "Other" please describe

Activities you are involved in*

If you selected "Clinician" in the list above, how many Clinic Days do you offer per year?

If you are an EAAT instructor, what program are you certified with?

*If you are certified please indicate length of certification below.

How many years have you been certified?

Average per month the number of students and/or horses you instruct*

Gross Annual Receipts for activities listed above*

NOTE: Gross Annual Receipts = the total amount of money received before subtracting taxes, costs and expenses.

Are you responsible for 24 hour care of non-owned horses? (either by boarding contracts or horses in training)*

Yes
No

If "Yes" to question above please indicate the Gross Annual Receipts and Average Number of Horses below.

Gross Annual Receipts

Average Number of Horses

Do you currently have a primary farm/ranch policy?

Yes
No

Do you currently have a policy that covers any of the above equine related exposures?

Yes
No

Do you have assistants or partners?*

Yes
No

If "Yes" for assistants or partners, how many?

Do you use volunteers or working students?*

Yes
No

NOTE: This includes anybody offering to take part in equine activities without remuneration. These individuals will NOT be giving lessons or advice as an expert or representative or acting as a person of authority (including any on ground instruction).

If "Yes" on volunteers, how many on average per month?

Do you offer any of the following additional activities?

NOTE: A reoccurring student is someone you have frequent contact with and have excellent working knowledge of their horsemanship.

Pony/Horse Rides

Yes
No

Includes traveling or at one location where horses or ponies are led in a round pen or hand held for special events, birthday parties, etc. Nor for reoccurring students (see definition above)

Gross Annual Receipts for Pony/Horse Rides

Number of Days for Pony Horse Rides

Day Camps

Yes
No

One day or multi day event offering equine activities or anything advertised as a "Camp". (For all events other than reoccurring 1 - 2 hour lessons and no overnight exposure.)

Gross Annual Receipts for Day Camps

Number of Days for Day Camps

Horse Drawn Vehicle Rides

Yes
No

Gross Annual Receipts for Horse Drawn Vehicle Rides

Number of Days for Horse Drawn Vehicle Rides

Fundraisers

Yes
No

Please describe any fundraising events.

Sleigh Rides

Yes
No

Horse Sales

Yes
No

Providing advice on purchase of a horse that is owned by you or not owned by you, whether in your care, custody, control or not. Also, if you receive any kind of remuneration or act as an agent/broker or if you have involvement in a horse auction.

If you answered Yes on Horse Sales, what are your Gross Annual Receipts for Horse Sales?

Guided Trail Rides

Yes
No

This includes trail rides led by you, a wrangler or any other party for recreational riding that is open to the general public for any length of time including hourly, long distance and/or multi-day trips.

Number of days for Guided Trail Rides

Trail Rides as part of a lesson

Yes
No

This is for reoccurring students (see definition above) that have trail rides as a part of their regular lesson.

Please list any additional activies not listed above.

How did you hear about us*

Other/Please Specify Details

Please list any additional comments

Phone

This field is for validation purposes and should be left unchanged.

New Trainer/Instructor Quote Request

Do you offer any of the following additional activities?