My Child Care Center is ... *

Licensed

In the process of obtaining a license

Not licensed (You must be licensed or in the process of becoming licensed in order to receive a quote.)

Do you have multiple locations? *

Yes

No

Contact Person *

First Name

Last Name

Business Phone *

(###)

###

####

Alternate Phone

(###)

###

####

Fax

(###)

###

####

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Operation(s)

Check all that apply.

Child Care / Day Care Center

Head Start Program

In-Home Day Care

Montessori School

Nursery School

Pre-School

Private School

Is your business currently insured?

Yes

No

Have you had any claims in the last 3 years?

Yes

No

Do you own your building?

Yes

No

What kind of construction is your building?

Aluminum siding or wood

Brick

Concrete

Any swimming activities (on or off premises)?

Yes

No

Any dogs or cats?

Yes

No

Do you have umbrella coverage?

Yes

No

Do you have commercial vehicles?

Yes

No

We need to make sure you're not a robot. (This question is intended to help reduce spam.) *

Are you:

Human

Robot

How would you like to be contacted regarding your quote?

Email

Phone

Fax

Mail