Certificate of Insurance Request Form Completion Guide
Rebekka Steenkamer
12 steps
3 minutes
1
Enter **THE CITY, DISTRICT, COMMISSION, FACILITY, ETC.** requesting the Certificate of Insurance **OR** **TO WHOM IT MAY CONCERN** if you are unsure of the exact entity requesting your Certificate of Insurance.
2
Enter the **ADDRESS** of the city, district, commission, facility, etc. requesting the Certificate of Insurance **OR** **LEAVE IT BLANK** if you are unsure of the exact entity requesting your Certificate of Insurance.
3
Enter the **NAME** of your Provincial Sport Organization (Water Polo West, Alberta Water Polo Association, Water Polo Saskatchewan, Manitoba Water Polo Association, Ontario Water Polo, Water Polo Québec, or Water Polo Atlantic).
4
Enter the **NAME** of the requesting organization (PSO or Club).
5
Enter the **NAME** of the requesting organization's contact. This contact is usually the President or main administrator.
6
Enter the **TELEPHONE NUMBER** of the requesting organization's contact. This contact is usually the President or main administrator.
7
Enter the **DESCRIPTION OF EVENT(S)** for which the requesting organization requires the Certificate of Insurance. **Example:** Water polo activities including dryland training, practices, games, scrimmages, tournaments/competitions/events, and camps/clinics - only members in good standing are covered.
8
Enter the **LOCATION(S)** **(Name and Address)** for which the requesting organization requires the Certificate of Insurance.
9
Enter the **DATE(S)** for which the requesting organization requires the Certificate of Insurance. **Example:** September 1, 2026 - August 31, 2027
10
**OPTIONAL:** Enter the **# OF DAYS** required for cancellation notice (if required).
11
**OPTIONAL:** Enter the **ADDITIONAL INSURED(S)** **LEGAL NAME**. If the requesting organization must include more than six additional insureds, please submit a separate document with the request form.
12
**Congratulations!** You have successfully completed the Certificate of Insurance Request Form. Please submit your completed form **at least 10 BUSINESS DAYS before your event** to allow sufficient time for processing. Email the completed form to **insurance@waterpolo.ca** and **cc your Provincial Sport Organization**. **Please note:** If the request is submitted fewer than **10 business days** before the event, Water Polo Canada cannot guarantee that the Certificate of Insurance will be processed and issued before the event date.
Certificate of Insurance Request Form Completion Guide
Rebekka Steenkamer
12 steps
3 minutes
1
Enter **THE CITY, DISTRICT, COMMISSION, FACILITY, ETC.** requesting the Certificate of Insurance **OR** **TO WHOM IT MAY CONCERN** if you are unsure of the exact entity requesting your Certificate of Insurance.
2
Enter the **ADDRESS** of the city, district, commission, facility, etc. requesting the Certificate of Insurance **OR** **LEAVE IT BLANK** if you are unsure of the exact entity requesting your Certificate of Insurance.
3
Enter the **NAME** of your Provincial Sport Organization (Water Polo West, Alberta Water Polo Association, Water Polo Saskatchewan, Manitoba Water Polo Association, Ontario Water Polo, Water Polo Québec, or Water Polo Atlantic).
4
Enter the **NAME** of the requesting organization (PSO or Club).
5
Enter the **NAME** of the requesting organization's contact. This contact is usually the President or main administrator.
6
Enter the **TELEPHONE NUMBER** of the requesting organization's contact. This contact is usually the President or main administrator.
7
Enter the **DESCRIPTION OF EVENT(S)** for which the requesting organization requires the Certificate of Insurance. **Example:** Water polo activities including dryland training, practices, games, scrimmages, tournaments/competitions/events, and camps/clinics - only members in good standing are covered.
8
Enter the **LOCATION(S)** **(Name and Address)** for which the requesting organization requires the Certificate of Insurance.
9
Enter the **DATE(S)** for which the requesting organization requires the Certificate of Insurance. **Example:** September 1, 2026 - August 31, 2027
10
**OPTIONAL:** Enter the **# OF DAYS** required for cancellation notice (if required).
11
**OPTIONAL:** Enter the **ADDITIONAL INSURED(S)** **LEGAL NAME**. If the requesting organization must include more than six additional insureds, please submit a separate document with the request form.
12
**Congratulations!** You have successfully completed the Certificate of Insurance Request Form. Please submit your completed form **at least 10 BUSINESS DAYS before your event** to allow sufficient time for processing. Email the completed form to **insurance@waterpolo.ca** and **cc your Provincial Sport Organization**. **Please note:** If the request is submitted fewer than **10 business days** before the event, Water Polo Canada cannot guarantee that the Certificate of Insurance will be processed and issued before the event date.
