2019/20 THSCA C0ACHES LIABILITY INSURANCE
The Texas High School Coaches Association offers a Coaches Professional Liability Insurance option to eligible members with coverage
beginning September 1, 2019. The THSCA has chosen the John A. Barclay Agency, Inc. to provide this policy to these members. This
plan was devised to offer liability insurance and legal assistance to THSCA members.
In order to be eligible for this policy you must meet the following criteria:
- You must be a Coach, Athletic Trainer or Athletic Director, including classroom duties, for an accredited secondary school,
college, junior college or university, within the state of Texas.
- Your THSCA Membership must be current for the school year in which the policy is effective - 9/1/19 through 8/31/2020.
- ACTIVE, ALLIED and LIFE members are eligible only if they meet the criteria above. This insurance is not available to STUDENT or
If you choose to purchase this insurance policy and do not meet the criteria for eligibility, this policy will not be valid.
This policy will be in effect September 1, 2019 through August 31, 2020. Policies purchased after September 1,
2019 will commence
coverage as of the payment received date. This insurance policy is not retroactive.
DEADLINE TO PURCHASE THIS 19/20 POLICY IS 1/31/2020.
Payment should be made directly to the THSCA.
The total 2019/20 annual premium for the insurance policy will be $54.00 per member.
Annual Insurance Premium…………………. $46.00 Checks made payable to: THSCA
State Taxes and Fees (5%)……..…………… $ 2.30 Mail payment to: THSCA, P.O. BOX 1138, San Marcos, TX 78667 or fax: 512-392-3762
Association Administrative Fee…………….$ 5.70 DO NOT MAIL PAYMENT to the John Barclay Agency.
TOTAL 2019/20 Annual Premium: $54.00 DEADLINE TO PURCHASE THIS 19/20 POLICY IS 1/31/2020.
Name: __________________ ________________ ______________ Today’s Date: ____/____/________
LAST FIRST MIDDLE
Member Number: ________________ 19/20 Membership Type (Circle One): ACTIVE ALLIED LIFE
Date of Birth: _____/_____/_________ Phone/Cell: _____________________________________
Mailing Address: ____________________________________________ Email: ____________________
STREET APT # CITY STATE ZIP
School Employed By: ______________________________ School District: _______________________
Job Title: _______________________________________ Primary Sport Coached: _________________
Signature: _________________________________ PAYMENT AMOUNT: $ 54.00
Checks made payable to: THSCA
Payment Method: _____CASH CHECK # ____________ CREDIT CARD: ___Visa ___MasterCard ___Discover
Credit Card Number: ____________________________________ Exp. Date: ______________ V-code: ___________
Card Holder’s Name: ____________________________________ Cardholders Signature: ________________________
Billing Address (if different from above): __________________________________________________________________________
STREET APT # CITY STATE ZIP
OFFICE USE ONLY:
Pymt Rec’d By: _____________________ Date: ____/____/_______ Insurance Input Date: ____/____/_______ By: _____________ 03/01/2019
click to sign
click to edit