2025 Student Accident Quote Request Form

School sports, special events and other activities are an important part of students’ lives, keeping them healthy, active and socially engaged. With Players Health’s Catastrophic Accident coverage, ensure your students and their families are financially prepared if a major incident occurs during a school-sponsored activity.

This is a request for proposal.

PLEASE NOTE: this is a PSBA Insurance direct-to-consumer product. If you are using a broker, please have the agency contact Torie Tezik at torie.tezik@psba.org for varying processes and requirements.

School entity *

Contact name *

First

Last

Phone *

Email *

How many students are enrolled at your school entity? *

Does your school entity currently provide Student Accident Insurance? *

Yes
No
Unsure

Which policy are you interested in receiving a quote for? *

Athletics & School Activities (No Football)
Athletics & School Activities (With Football)
All School Activities

Please select all that apply.

Signature *

Clear Signature