When an incident, first aid event, trip or fall happens the the time to fill out the Incident Report form is right away. Document what happened using the Incident Report Form. Download the Incident Report Form here.
Medical Loss Form
NEW Request for Certificate of Insurance
Do you have a special event or activity such as one of the following coming up soon:
+ health fair,
+ school picnic,
+ clean up day,
+ field trip to a cargo ship,
+ other activity or special event
that requires renting property and/or office and/or audio equipment? When we have these types of events, each venue may request a Certificate or Proof of Insurance from our insurance carrier.
Please download and complete the NEW Request for Certificate of Insurance form and email it to firstname.lastname@example.org, so we can process your request in a timely manner. Please allow at least two weeks for completion. Click here for samples of the request form: Sample Activity Request or Sample Copy Machine Request.
Permission, Consent and Release Forms
Carefully read and review this church entity waiver.
School Permission Slip
All field trips and most other activities, including sports tournaments, may require completion of a permission slip.
School Optional Insurance Parent Waiver
Have parents fill this out as an acknowledgement that they have received information in regards to optional coverages from our student accident provider, MST, and they either choose to accept or forego the optional plans.
Short Term Travel
If you are taking a trip out of the country for business or pleasure, and qualify to buy Short Term Travel Insurance, download this form, complete it, and email it to us to apply for coverage: Short Term Travel Insurance.
Whether you are a volunteer or a missionary traveling on an approved activity of the church/school, or a NCC employee (or retiree) on a business trip or vacation, this coverage is for you.
Coverage is available worldwide
Step 1: Download the Mission Trip Application and complete the form.
(Click here for a Sample Travel Worksheet. Download the Travel Worksheet.)
IMPORTANT MESSAGE TO: Minors traveling without parent(s) / guardian(s):
Submit this notarized form to Risk Management PROMPTLY: The Letter of Consent to Travel.
Step 2: Submit your mission trip application with the travel worksheet to the Executive Secretary's office for review.
(Recommended submission is 4 months prior to travel).
Step 3: Administrive Counsel will then vote on the mission trip application to approve or deny the trip.
Step 4: Once the trip has been approved, please apply for the appropriate insurance below.
(Be sure to apply with enough lead time for all the steps in the process.)
Download these forms to apply for Short Term Travel Coverage and Volunteer Labor Coverage:
Short Term Travel Coverage (anyone traveling needs this)
Volunteer Labor Coverage (if it applies; cooks probably don't; bricklayers would)
NEW Auto Change Request Form
When purchasing a new or used vehicle, the business name needs to be: Northern California Conference of Seventh-day Adventists, there should be a Doing Business As (DBA) for the name of the church, school, or other entity.
Any newly acquired vehicle to the church or school, needs to have appropriate auto insurance coverage. To add this to our auto policy, please complete the form and submit it to the Risk Management deparment via email it to email@example.com. Conversely, if a vehicle has been sold, auto insurance coverage needs to be deleted. Complete the change form, email or fax to Risk Management with notification.
NEW ARM Property Application Form
Any newly acquired building to the church or school, needs to have current property insurance coverage. The information required on the form is necessary to add this to our property insurance policy. Please complete the form and submit it to the Risk Management. Conversely, if a property has been sold, property insurance coverage needs to be deleted. Do notify us immediately.
Contact the RISK MANAGEMENT DEPARTMENT with your questions.
Northern California Conference of Seventh-day Adventists | 401 Taylor Blvd. | P.O. Box 23165 | Pleasant Hill, CA 94523 | (925) 685-4300 | firstname.lastname@example.org