Adventure Tourism Supplementary Questionnaire For Fishing Challenge Insurance Group Inc.
Phone: (780) 487-2444 Suite 201, 11238 – 170 Street Edmonton, Alberta T5S 2X1 Fax: (780) 487-2554 Toll Free: 1-877-642-2444
SECTION 1: GENERAL INFORMATION 1. Describe the fishing operation in detail: ___________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 2. What does your fishing package include? _________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 3. How long have you offered this activity? ___________________________________________________________________ 4. What is your operating season? _________________________________________________________________________ ____________________________________________________________________________________________________ 5. Do you provide transportation for your participants? 6. Do you supply any equipment to your participants? Yes Yes No No
If “Yes”, please indicate equipment supplied: ______________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 7. Do you rent any equipment to your participants? Yes No If “Yes”, please indicate equipment rented: ________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 8. Please give details of the boats that are used for each of this activity: ___________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 9. Do you provide or help to procure a license for fishing to the participants? SECTION 2: PARTICIPANT INFORMATION 1. How many participants do you have in a year for this activity: _________________________________________________ 2. Do you have a minimum age requirement for participants? 3. Please describe participants for an average trip: Total Participants: _____________ # Under 18: _____________ # Above 18: _____________ Yes No If under 18, do you get the consent form and waiver signed by a parent or legal guardian: 4. In your opinion, how many of the participants per trip are classified as: Novice Level (little or no experience): _____________ Senior Level: _____________
Adventure Tourism – Fishing
Yes
No
Yes
No
If “Yes”, please specify minimum age: _____________________________________________
Intermediate Level (some experience): _____________ Total Participants: ___________
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Advanced Level (certified level): _____________
5. How many participants do you have for each of the trip itineraries that you offer and your participants to guide ratio? Activity Trip Itinerary Number of Participants Participant to Guide Ratio
SECTION 3: GUIDE COMPETENCIES 1. Do all the guides have wilderness first aid certification? Yes No Yes No
2. Are the guides, assistant guides and safety boaters certified in swift water rescue?
3. If the safety boaters are not certified by an outside organization, please describe their qualifications and experience: ___ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 4. What are the minimum qualifications and experience you require to hire guides for this operation? __________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 5. Are all guides required to have a Pleasure Craft Operator Card? 6. Do you provide training to your guides? SECTION 4: SAFETY INFORMATION 1. Please list all safety equipment worn by participants while on the trips: __________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 2. Do you require all participants to wear approved personal flotation devices? 3. Do you require all your participants to wear wet suits? Yes No Yes No Yes Yes No No
Please explain: _______________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 4. Do you do any single boat trips? Yes No Please explain: _______________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 5. Do you follow the water quality guidelines of Canada? Yes No Please explain: _______________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 6. Do you have any fishing guidelines or do you follow the fishing guidelines developed by some other organizations? Yes No Please explain: _______________________________________________________________________________________ ____________________________________________________________________________________________________
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7. How often do you check your equipment, including boats? ___________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 8. How often do you replace your equipment, including boats? __________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 9. Do the guides carry communication devices? Yes No 10. Describe participant management procedures for these activities: ______________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 11. Describe actions taken and decisions made to avoid specific hazards in this activity (ie. things you do or do not do): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 12. Describe actions taken and decisions made to reduce the frequency of accidents in this activity (preventing incidents): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 13. Describe actions taken and decisions made to reduce the severity of accidents in this activity (ie. reducing the impacts of an incident): _________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ SECTION 5: OPERATING TERRAIN & TRIP INFORMATION 1. Type of fishing: Casting Fly Float Ice Other (please specify): ____________________ Boat: ______% Other (please specify): ____________________ 2. What percentage of fishing is: Wading: ______% 3. Where is fishing conducted: Lake Pond Stream Sea 4. What is the maximum length of your fishing trips: ___________________ 5. Maximum participant capacity per boat: __________________________ Number of guides per participant: _______________________________ Number of guides per boat: ____________________________________ 6. Are participants allowed to drive boats? Yes No 7. Describe the boat or floating device used for fishing: ________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Shoreline: ______%
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8. Please describe the exact location and type of boat used for the fishing itineraries (specific area, name of area, location or star and end, difficulty, etc.): Class of Water Name of Type of boat Location of Route Location of Length river / creek used+ start Taken finish Kms/days 1 2 3 4 / sea Singles(S) or Multiple(M) boat trips
9. Do you have any side trips on any activities?
Yes
No Yes No
10. Do you need to cross any open water on your fishing activity?
11. Describe your onshore activities, if any: ___________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Enclose a copy of a map, drawing or description that the trip will take and identify all trails and portage taken. SECTION 6: OTHER INFORMATION 1. Please provide any other information you feel would assist in the evaluation of your application: ____________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
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SECTION 7: BROKER INFORMATION BROKER CONTACT INFORMATION Agent Name: Broker Name: E-Mail: Phone: Fax: SECTION 8: DECLARATION It is understood and agreed that the completion of this application shall not be binding either to the proposed insured or to Challenge Insurance Group Inc./Echelon General Insurance Company until accepted by Challenge Insurance Group Inc./Echelon General Insurance Company but that the information contained herein shall be the basis of the contract should a policy be issued. I declare that the statements made in this application are complete and true to the best of my knowledge. I understand that the Application Form will form part of the insurance policy provided through Echelon General Insurance Company (EGIC). I acknowledge that if, at any time of claim, it is discovered that any question in this application is not answered truthfully, accurately and completely, it may result in the non-payment of any claim and/or my coverage will be made null and void. Your privacy is protected: The insurance coverage you are applying for is underwritten by EGIC and provided to you by Challenge Insurance Group Inc. EGIC and Challenge Insurance Group Inc. will collect, use and disclose the personal information, which you give, for the purpose of providing you with insurance services. Your information may be disclosed to others in the credit services, investigative and/or insurance fields as necessary to underwrite and administer this insurance and to pay any benefits. Full details regarding how Your privacy is protected can be obtained by asking Challenge Insurance Group Inc. for a copy of EGIC’s Privacy Policy.
Address: City: Province: Postal Code:
APPLICANT’S NAME (PLEASE PRINT)
SIGNATURE OF APPLICANT
DATE (MM/DD/YYYY)
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