Adventure Tourism Supplementary Questionnaire For Fishing Challenge Insurance Group Inc

							                                          Adventure Tourism Supplementary Questionnaire
                                                            For Fishing

                                                        Challenge Insurance Group Inc.
                                                               Suite 201, 11238 – 170 Street
                                                                Edmonton, Alberta T5S 2X1
                              Phone: (780) 487-2444                   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?                          Yes              No
     6. Do you supply any equipment to your participants?                             Yes              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?                   Yes                   No


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?                                Yes               No
          If “Yes”, please specify minimum age: _____________________________________________
     3. Please describe participants for an average trip:
                    Total Participants: _____________                   # Under 18: _____________            # Above 18: _____________
          If under 18, do you get the consent form and waiver signed by a parent or legal guardian:                          Yes          No
     4. In your opinion, how many of the participants per trip are classified as:
          Novice Level (little or no experience): _____________                   Intermediate Level (some experience): _____________
          Senior Level: _____________                 Advanced Level (certified level): _____________        Total Participants: ___________


Adventure Tourism – Fishing                                                                                                          Page 1 of 5
     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
     2. Are the guides, assistant guides and safety boaters certified in swift water rescue?         Yes                No
     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?              Yes             No
     6. Do you provide training to your guides?                      Yes             No


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?                 Yes                No
     3. Do you require all your participants to wear wet suits?            Yes                 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: _______________________________________________________________________________________
          ____________________________________________________________________________________________________

Adventure Tourism – Fishing                                                                                                  Page 2 of 5
     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): ____________________
     2. What percentage of fishing is:
              Wading: ______%                   Shoreline: ______%                 Boat: ______%
     3. Where is fishing conducted:
              Lake            Pond              Stream            Sea              Other (please specify): ____________________
     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: ________________________________________________________
          ____________________________________________________________________________________________________
          ____________________________________________________________________________________________________




Adventure Tourism – Fishing                                                                                                Page 3 of 5
     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.):
         Name of         Type of boat       Location of Route         Location of     Length                 Class of Water
         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
     10. Do you need to cross any open water on your fishing activity?               Yes               No
     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: ____________________
          ____________________________________________________________________________________________________
          ____________________________________________________________________________________________________
          ____________________________________________________________________________________________________
          ____________________________________________________________________________________________________
          ____________________________________________________________________________________________________




Adventure Tourism – Fishing                                                                                                    Page 4 of 5
SECTION 7: BROKER INFORMATION


BROKER CONTACT INFORMATION
Agent Name:                                                          Address:
Broker Name:
E-Mail:                                                              City:
Phone:                                                               Province:
Fax:                                                                 Postal Code:


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.




APPLICANT’S NAME (PLEASE PRINT)                       SIGNATURE OF APPLICANT                                DATE (MM/DD/YYYY)




Adventure Tourism – Fishing                                                                                                  Page 5 of 5