Francis L. Dean & Associates
Intercollegiate Sports Census
Page 1 of 2
Name of Institution:_______________________________________________________
Address:_______________________________________________________________
City:_________________________________ State:_________ Zip Code:____________
School Contact:__________________________ Phone Number:____________________
(NAME/TITLE)
SPORTS TO BE INSURED
***Please indicate # of athletes in each sport listed:
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Males
|
Females
|
|
Baseball
|
_____
|
_____
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|
Basketball
|
_____
|
_____
|
|
Bowling
|
_____
|
_____
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|
Boxing
|
_____
|
_____
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|
Cheerleading
|
_____
|
_____
|
|
Cross Country
|
_____
|
_____
|
|
Field Hockey
|
_____
|
_____
|
|
Football (Fall)
|
_____
|
_____
|
|
Football (Spring)
|
_____
|
_____
|
|
Golf
|
_____
|
_____
|
|
Gymnastics
|
_____
|
_____
|
|
Ice Hockey
|
_____
|
_____
|
|
Lacrosse
|
_____
|
_____
|
|
Rodeo
|
_____
|
_____
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|
Rowing / Crew
|
_____
|
_____
|
|
|
|
|
Males
|
Females
|
|
Rugby
|
_____
|
_____
|
|
Skiing
|
_____
|
_____
|
|
Soccer
|
_____
|
_____
|
|
Swimming
|
_____
|
_____
|
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Tennis
|
_____
|
_____
|
|
Track/Field
|
_____
|
_____
|
|
Volleyball
|
_____
|
_____
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|
Water Polo
|
_____
|
_____
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|
Weightlifting
|
_____
|
_____
|
|
Wrestling
|
_____
|
_____
|
|
Other ___________
|
_____
|
_____
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Other ___________
|
_____
|
_____
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Other ___________
|
_____
|
_____
|
|
Other ___________
|
_____
|
_____
|
|
Other ___________
|
_____
|
_____
|
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Questions? Call us at (800) 745-2409.
Click here for page two. (Required)
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