Property & Casualty
Shadow Lake Insurance
276-597-9844
Gym · Intake
Gym Intake
Tell us about the gym. Most questions are optional. You can attach the lease, loss runs, current insurance, and a copy of the member waiver if you have them. Shadow Lake Insurance will follow up with you.
Company website
Main Contact
First Name
*
Last Name
*
Email
*
Phone
*
Inspection contact name
Optional. Only if someone other than the main contact should meet the inspector.
Inspection contact phone
Business
Legal business name
*
The name that should appear on the policy.
DBA / trade name
Leave blank if you do not use a different public name.
Form of business
*
— Select —
Individual
LLC
Corporation
Partnership
Joint venture
Trust
Other
Website
Optional.
Year the business started
*
Four-digit year, such as 2016.
Years at this location
Mailing address
Is the mailing address the same as the gym address?
Yes
No
Mailing street
Mailing city
Mailing state
Mailing ZIP
Franchise
Are you a franchisee?
Yes
No
Franchisor name
Franchisor address
Have you ever acted as a franchisor?
Yes
No
Gym's Information
Tax EIN
List Owner(s) & DOB
For each owner, include or exclude them from workers comp, and list duties
Example: Jane Roe — exclude — owner/manager. John Doe — include — front desk.
Desired effective date
Address
Street Address
*
City
*
State
*
Country
— Select —
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czechia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Postal Code
*
Locations
Location name
What you call this gym.
Is this the primary location?
Yes
No
Do you have more than one location?
Yes
No
Other locations
One line per location: Name | Street | City | State | ZIP | Primary (Yes or No).
Location name
Street
City
State
ZIP
Primary (Yes/No)
Add another location
Is the exposure annual, a single event, or both?
Annual
Event
Both
Is this a seasonal operation?
Yes
No
Which months are you open?
Off-site activity
Do you hold pop-ups, demos, or outdoor classes away from the gym?
Yes
No
Where and how often?
Do you host overnight retreats?
Yes
No
Describe the retreats
Any hiking, walking, biking, climbing, or on-water activity?
Yes
No
Describe those activities
Any activities on residential property?
Yes
No
Describe the residential-property activities
Location Information
What is the square foot of your location?
Numbers of levels of just your location?
What is the year the roof was built and/or replaced?
What type of roof is on your location?
Do you own or lease your location?
The space you occupy. Choose Own if you also own the building.
Own
Lease
Is your Location a stand-alone or located in a shopping center?
Stand-alone
Shopping Center
Other
Does Your Location have an AED Machine?
Yes
No
Building Information
How many levels are in your shopping center?
What is the approximate year your location was built?
Building and property
Building construction
Choose Not sure if you do not know.
— Select —
Frame
Joisted Masonry
Non-Combustible
Masonry Non-Combustible
Modified Fire Resistive
Fire Resistive
Not sure
Building occupancy
— Select —
Gym / fitness only
Office
Workshop
Apartment
Mixed
Other
Square feet of the whole building
The entire structure, not only the space you occupy.
Square feet leased to other commercial tenants
Apartment units in the building
Apartment square feet
Plumbing type
— Select —
PVC
Copper
Galvanized
Lead
Mixed / other
Not sure
Is the building 100% sprinklered?
Yes
No
Not sure
Burglar alarm type
Local
Central
None
Are there smoke or heat detectors in all public areas?
Yes
No
Any aluminum or knob-and-tube wiring?
Only for buildings built before 1978.
Yes
No
Not sure
Is the building on 100% circuit breakers?
Yes
No
Not sure
Is any building a nonstandard structure (bubble or dome)?
Yes
No
Describe the nonstandard structure
Property values
Building limit ($)
What the building should be insured for. Leave blank if you do not want property coverage.
Tenant improvements and betterments ($)
Business personal property / contents ($)
Business income limit ($)
Property deductible preference
— Select —
$1,000
$2,500
$5,000
$10,000
$25,000
Other / not sure
Operations and exposures
Is this a facility, mobile / non-facility, or both?
Facility
Mobile / non-facility
Both
Activities offered
Check every activity you offer.
General fitness
Personal training
Group fitness
Spin
Strength training
HIIT / boot camp
CrossFit
Yoga / Pilates
Zumba / dance
Aerial yoga / pole
Martial arts / boxing
Sparring / physical contact
Gymnastics / trampoline
Climbing wall - traverse/bouldering
Climbing wall - roped
Zipline / ropes / silks / trapeze
Other
Other activities
Description of operations
Optional. A short narrative of what the gym does day to day.
Amenities and other exposures
Treadmills
Swimming pools
Hot tub / sauna / steam
Showers
Locker room
Sports courts
Massage units
Tanning units
Child sitting
Birthday parties
Inflatables
Soft play
Batting cages
Retail / smoothie bar
Online coaching
Transporting participants
Retail sales annual amount ($)
Do you have booster clubs?
Yes
No
How many treadmills?
How many pools?
How many sports courts?
How many massage units?
How many tanning units?
More than 4 tanning units?
Yes
No
Are the tanning units UL listed?
Yes
No
Do minors need a parent release for tanning?
Yes
No
Is a pregnancy and photosensitive warning posted?
Yes
No
Do only staff have access to the tanning unit controls?
Yes
No
Are protective goggles required?
Yes
No
Do you keep tanning usage logs?
Yes
No
Are background checks done for child-sitting staff?
Yes
No
Do you watch infants under 6 weeks?
Yes
No
Is there a sign-in and sign-out process?
Yes
No
Must a parent or guardian stay on the premises?
Yes
No
Services
Any medical, blood analysis, stress testing, cryotherapy, salt therapy, or spa services?
Yes
No
Which of those services, and who provides them?
Do your employees provide chiropractic, physical therapy, or rehab?
Yes
No
Do you manufacture or repackage diet aids, vitamins, or supplements?
Yes
No
Do you sell or serve liquor?
Yes
No
Liquor sales ($)
Enter 0 if this does not apply.
Hours and staffing
Are you open 24 hours?
Yes
No
Is a CPR-certified staff member on duty during all open hours?
Yes
No
Can members get in when the gym is not staffed?
Yes
No
Is the facility staffed during all hours you are open?
Yes
No
Participants by age
Participants age 12 and under
Estimated headcount for the next year. These four bands are what the carriers quote from.
Participants age 13 to 15
Participants age 16 to 18
Participants age 19 and over
How many coaches, trainers, or officials?
Are any players paid to participate?
Yes
No
Are activities sanctioned by a school?
Yes
No
Is your organization itself a National Governing Body?
Yes
No
Governing body name
Insurance Questions
Estimate number of full-time employees?
Total anticipated payroll for full-time employees upcoming 12 months?
Estimate number of part-time employees?
Total anticipated payroll for part-time employees upcoming 12 months?
Do you have any 1099 or contractors?
Yes
No
If you do have any contractors/1099 do they carry their own insurance?
Yes
No
N/A
What is your estimated annual gross revenue?
What is your current premium for gym(s)?
Risk management
Do you require a signed waiver from every member, guest, and participant (or a parent/guardian)?
Yes
No
Does a code of conduct define prohibited behavior?
Yes
No
Are adult participants clearly defined?
Yes
No
Are all trainers and instructors certified?
Yes
No
Are fitness staff CPR and AED certified where required?
The AED question in Location Information is separate.
Yes
No
Do you have a certification and continuing-education policy?
Yes
No
Do you run background checks on staff?
Yes
No
What does a background check include, and what disqualifies someone?
Abuse prevention
Do staff who work with minors get abuse-prevention training?
Yes
No
Do you have a written abuse-prevention policy and mandatory reporting rules?
Yes
No
Do you have a policy on one-on-one adult/minor interaction?
Yes
No
Safety and equipment
Do you have a written cardiac-arrest and heat-illness policy?
Yes
No
Does member orientation include a treadmill tutorial?
Yes
No
Are warning signs posted at tanning units, hot tubs, saunas, and equipment?
Yes
No
Do you keep equipment service and maintenance logs?
Yes
No
How often is equipment inspected?
Daily, weekly, and monthly is enough detail.
Do you have an equipment installation policy?
Yes
No
Do you have a daily disinfecting plan?
Yes
No
Are risk policies current, shared with staff, and posted on the website?
Yes
No
Cameras
Do cameras record inside the facility?
Yes
No
Do cameras record outside the facility?
Yes
No
Autos and rented space
Do professionals who rent space carry their own insurance and name the gym as an additional insured?
Yes
No
N/A
Autos
Do employees or volunteers drive for the gym?
Yes
No
Is a commercial auto policy already in force?
Yes
No
Do you verify personal auto insurance for people who drive?
Yes
No
Are motor vehicle records pulled for drivers?
Yes
No
Will you start verifying personal auto insurance / pulling driving records?
Yes
No
How many employees drive for the gym?
How many volunteers drive for the gym?
Estimated annual cost of hired or leased vehicles ($)
Enter 0 if you do not hire vehicles.
Are vehicles used to transport people or goods?
Yes
No
Prior coverage and losses
Current insurance carrier
The company on the policy now. Leave blank if this is a new gym.
Current policy expiration date
Any insurance claims in the last 5 years?
Yes
No
Claim details
For each claim: date, type, what happened, amount paid, amount reserved, and whether it is open or closed.
Was any claim in the last 5 years $25,000 or more?
Yes
No
Explain the claim of $25,000 or more
Has a carrier cancelled or non-renewed a policy?
Yes
No
What happened, and when?
Has the business or any owner/officer had a bankruptcy, foreclosure, or tax lien in the past 5 years?
Yes
No
When?
Describe the bankruptcy, foreclosure, or tax lien
Any actual or alleged sexual abuse or molestation incident?
Yes
No
Describe the incident
Coverage requested
Coverage you want quoted
Check every line you want.
General liability
Property
Professional liability
Errors and omissions (E&O)
Participant accident (A&H)
Abuse and molestation
Hired and non-owned auto
Liquor liability
EPLI
Umbrella
Workers compensation
Employee benefits
Crisis response
Stop gap
Participant liability
General liability occurrence / aggregate limit
— Select —
$100,000 / $200,000
$300,000 / $600,000
$500,000 / $1,000,000
$1,000,000 / $2,000,000
$1,000,000 / $3,000,000
$2,000,000 / $4,000,000
$2,000,000 / $5,000,000
Other
Abuse and molestation limit
— Select —
$25K/$100K
$100K/$300K
$300K/$300K
$500K/$500K
$1M/$1M
Not requested
Medical payments for athletic participants
None
$5,000
$10,000
$25,000
Do you want a blanket additional insured?
Yes
No
Do you need a waiver of subrogation?
Yes
No
Who needs the waiver, and how many?
Do you need primary and non-contributory wording?
Yes
No
Additional interests
One per line: name, address, and relationship (landlord, franchisor, equipment lessor, mortgagee, loss payee, or other).
Umbrella limit
$1,000,000
$2,000,000
$5,000,000
Other
EPLI limit
— Select —
$100,000
$250,000
$500,000
$1,000,000
Other
Documents
Lease (if applicable)---Run/Loss (If not a new gym, ask current insurer)---Current Insurance---Copy of member waiver
Optional. PDF, images, Word, or Excel. 10 MB each, 25 MB total.
Submit
