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Stacy Lane
Director, JPA Services
445-7055
slane@humboldt.k12.ca.us

Susan Bishop
JPA Secretary
445-7126
sbishop@humboldt.k12.ca.us

Kimberly Comet
Risk Manager
445-7067
kcomet@humboldt.k12.ca.us
North Coast Schools' Insurance Group (NCSIG)
Forms

Auxiliary/Foundation Organization Policy Application
(PDF)

Certificate of Coverage Request
(DOC)

Claim Presented to School District
(PDF)
- Please print both sides

JPA 1 - Field Trip/Excursion Waiver and Medical Authorization-Minor
(PDF)

JPA 1(B) - Field Trip/Excursion Form
(PDF)

JPA 2 - Acknowledgement & Assumption of Potential Risk
(PDF)

JPA 4 - Reimbursement Request for Safety Credits
(PDF)

JPA 14 - Field Trip Driver Form
(PDF)

JPA 19 - Playground Equipment
(PDF)

JPA 24 - Physical Evaluation
(PDF)

Property Claim Form
(DOC)

Vehicle Claim Form
(DOC)

Property Endorsement
(PDF) (DOC)

Vehicle Request
(PDF) (DOC)

Volunteer Registration Form
(PDF)

First Aid Incident Form
(PDF)