EmailMe Form - Certificate of Insurance Request Form

Name of person submitting form. *

First Last

Email *

Unit Type *

Unit Number *

Enter your 4-digit unit #. ex. 4001
For district/council events, enter 0000

Town / Community *

Date/s of Activity: *

Amount being requested *

Make sure you have confirmed with the facility exactly what they require, do not guess.

Certificate Holder Name: *

Confirm with the facility exactly who they require the certificate to be made out to i.e. not the school, but the school district.

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Description of Activity/Event: *

If certificate is for use of facilities, please describe:

Are there any fees required for services, use of property, etc.? *

Yes

No

If yes, what fee amounts are being charged?

Upload here any facility use forms/documentation from the facility for your event/days of use.

If your file size is too large, please forward the email confirmation (that you receive after submitting this form) with your files as PDF attachments.

Are there any additional notes or comments that you feel we should know?

If for Eagle Project, be sure to include this information---

1. The exact address of the location of the work being performed.
2. The exact dates of the work being performed--(if not known as an example, you can list "every Saturday and Sunday in April")
3. The Scouts name who is running the Eagle Project
4. Name of the project and description of work to be done (example: Park Beautification-building benches and then digging holes securing with cement-clearing out weeded areas, planting new greenery and laying pea gravel around perimiter

You will receive an email from GHV.Service@Scouting.Org with your certificate as soon as it's been processed.
**on the next screen, it will say that your "Submission has been Saved". This means that we have received it, please do not resubmit.