Laser Tag Insurance Questionnaire

Laser Tag Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
OPERATIONS
1. What are the hours of operation?
2. Are special parties offered after normal business hours?

YesNo
2a. If yes, is the general public allowed on premises during this time?

YesNo
3. Do you require all participants to sign a waiver of liability? (If yes, please attach a copy.)

YesNo
3a. If yes, do all minors have their parents or guardians sign their forms?

YesNo
4. What is the minimum age for players?
5. Are adults and children allowed to participate in the playing zone at the same time?

YesNo
6. What is the maximum number of players allowed in the playing zone at one time?
7. Do you use Game Masters/Referees in the playing zone?

YesNo
7a. If yes, what is the ratio of players to game masters/referees?
7b. Please describe your procedure for training of the game masters:
8. Are there any additional services or activities taking place on premises?

YesNo
8a. If yes, please describe:

9. What are the Gross Sales for:

10. Do staging areas have Safety Rules posted? (If yes, please provide picture.)

YesNo
10a. If yes, do they include no running, climbing, crawling and physical contact warning signs?

YesNo
11. Are safety briefings held prior to being allowed to play?

YesNo
12. Do Emergency Procedures exist?

YesNo
12a. If yes, are all employees trained in the Emergency Procedures?

YesNo

Rows	Yes	No
1a. On prospective employees and volunteers?
1b. On existing employees and volunteers?

Rows	Yes	No
4a. Abuse and Molestation?
4b. How to recognize the signs of abuse?
4c. What to do if an individual reports someone molested him/her?