Insurance Forms | Crossroads of America Council, BSA

Insurance Forms for Boy Scouts of America

Accident and Illness Insurance Forms

The BSA Incident Report should be completed to report all injuries, illnesses, and incidents that occur during Scouting activities or on council-owned properties that require immediate or potential intervention or a medical provider beyond basic Scout-rendered first aid. Once completed, this report should be forwarded to Natalie Pearce by email or returned at the Golden-Burke Scout Center.

BSA Incident Report

All Crossroads of America Council youth members and registered adult volunteers are covered by the BSA Accident & Sickness Insurance Plan for injuries or illnesses sustained on an official Scout outing. This insurance plan is administered by Health Special Risk Insurance and is in excess of any coverage provided by the injured Scout or volunteer’s primary insurance. For questions of the BSA Accident & Sickness Insurance Plan, please refer to the following document or contact  Natalie Pearce by email or by phone at (317) 813-7067.

Accident and Illness Insurance Plan Booklet
Accident and Illness Insurance Claim Form
Accident and Illness Insurance FAQs


Certificate of Insurance

Units may request a Certificate of General Liability Insurance from the council. This is a document that gives evidence that the BSA has insurance to cover the claims for which they may be responsible. A Certificate of Insurance can only be issued for an authorized BSA activity. For unit fundraising activities, a unit fundraising application must also be filed and approved. To request a certificate of insurance, complete the request form and forward it to Reem Okar by email or return it to the Golden-Burke Scout Center. Please allow seven working days for completion. For certificates naming an additional insured or with special wording, please allow 14 working days. 

Request for Certificate of General Liability Insurance

Have a question about, or issue with, one of the forms above?