Field Trip Insurance Request
Field trip insurance covers BYUH-enrolled students participating in university-scheduled, sponsored, and supervised academic or education-related field trip experiences.
Requestor
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Manager
*
First Name
Last Name
Manager's Email
*
example@example.com
Department
*
Course Name
Faculty Member
First Name
Last Name
Coverage Start Date
*
-
Month
-
Day
Year
Coverage End Date
*
-
Month
-
Day
Year
Total Day(s) of Coverage
Activity Location
*
Types of Activities
Select the type(s) of activities students will do on the field trip. Check all that apply.
For single-day events, please select the classification of activities that represent the riskiest activity for the trip. For multi-day events, please identify the riskiest activity for each day of the trip. The total charge will be calculated as a sum of those day-to-day charges.
*
($0.23) Standard activities and field trips including limited travel and moderate to low risk walking activities, (e.g. indoor walking tours, museums, city centers).
($0.29) Riflery (shooting activities).
($3.17) Scuba divings
($1.96) River rafting, kayaking, and swimming.
($1.44) Planned, high-adventure activities, (e.g. ropes courses, hiking, mountain biking, cycling, cross-country skiing, leadership training, overnight survival, and similar activities) not listed in other categories.
($1.96) Downhill skiing, cave crawling, rock climbing, rappelling.
($1.21) Academic field research (including but not limited to traffic studies, collecting data from soil research or samples, or low impact environment studies relating to construction design or projects).
($5.46) ATV activities (including skills training, driving and riding in).
Detailed Activity Description
Provide detailed description of the day-to-day activities.
Example: September 12 - Walking tour of Bishop Museum or September 13 - Games in the park, including picnic and swimming.
*
Participants
Enter the participants' information below OR upload a roster below.
Number of Participants
*
Roster file(s) upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Account Information
Cost Center (6 digits) H:CC
*
Student Club Worktag (if any)
Gift Worktag (if any)
Additional Information or Comments
Requestor's Signature
*
Comments and total insurance cost
*
Print
Save
Submit
Clear All Questions
Should be Empty: