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Therapy Dog Handler Liability Application
 
 
Calculate Your Annual Premium
Type of Application:*


Basic Liability Rate:
For one handler and one dog.
Your Basic Liability Rate:
$175.00

How many dogs?
$25.00 for each additional dog insured.*
How many Additional Insured?**
Additional $25.00 each.*
**Additional Insureds consist of hospitals, building owners, apartment complexes, parks, municipalities or other entities where you may work, requesting to be listed under your policy.


Subtotal:

$25.00 Policy Fee/Taxes:
$25.00

Total Annual Premium:

 
Policy Holder Information
First Name:*
Last Name:*
Phone Number:*
Email Address:*
 
Types Of Therapy Work
Please check all types of therapy work you and your dog(s) will be performing:*







If Other: Please Describe:
 
Primary Business Physical Address:
Address:*
City:*
State:*
Zip Code:*
 
Mailing Address (If different than business address)
Address:
City:
State:
Zip Code:
 
Dog Information (1)
Dog's Name:*
Dog's Breed:*
Dog's birthdate or approximate age:*
 
Certification/Registration: Please send proof of certification/registration from Alliance of Therapy Dogs, Pet Partners or other approved organization for each dog listed. The registration must include the dog's name, breed, and certification expiration date. You can choose to email it to us at certificates@business-insurers.com, fax it to us at 919-537-0750 or mail it to Business Insurers of the Carolinas, PO Box 2536, Chapel Hill, NC 27515. We will not be able to process your application until we have a copy of this certificate.
 
Payment Information
Pay by:*

 
Would you like to receive an invitation to our online portal where you can access your certificates of insurance 24/7:*

Registration/Certification Disclaimer:*
Disclaimer:*
 
Minimum earned policy premium of 25% applies to this policy. By clicking the "Submit" Button you are acknowledging that you agree to be charged a total premium and the policy fee of $25.00.

*This application does NOT constitute a binder.
 
 
*Required fields:

Security:
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