Accident & Medical Insurance
for Youth Sports Leagues & Teams
M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway     Murrysville, PA.   15668-1890
(724) 327-8474              (Fax: (724) 327-7911
Toll Free: 1-800-977-2999                 Fax: 1-888-800-0034
www.McGrathInsuranceGroup.com         McGrathInsurance@aol.com
Name of Group:
     Contact Person: 
Mailing Address:
City:
     State:       Zipcode: 
Phone:
        Cell: Phone:        Fax: 
E-Mail Address(s):
Sport/Activity to be Covered:
Beginning Date of Coverage               Ending Date of Coverage:  

 
Current or Requested Coverage Accidental Death & Dismemberment Accidental Medical Expense Deductible Coverage
$  $  $ 
If sports are to be covered 12 years & Under 13 to 15 16 to 18 Adult
Baseball
Basketball
Cheerleading
Cross Country
Fencing
Field Hockey
Football
Golf
Gymnastics
Ice Hockey
LaCrosse
Rifle
Rodeo
Skiing
Soccer
Softball
Swimming/Diving
Tennis
Track/Field
Volleyball
Wrestling
Trainers/Managers    
Coaches    

Existing Coverage (coverage history)

Company Policy Dates Premium Claims Paid
to 
to 
to 
to 

 

M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway, Murrysville, PA. 15668-1890
(724) 327-8474           (fax) 327-7911
Toll Free: 1-800-977-2999      Fax: 1-888-800-0034