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

Mendie Ballester
JPA Secretary
445-7126
mballester@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)
English

Certificate of Coverage Request (Doc)
English

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

First Aid Incident Form (PDF)
English

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

JPA 1(A) - Field Trip/Excursion Form (PDF)
EnglishSpanish

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

JPA 4 - Reimbursement Request for Safety Credits (PDF)
English

JPA 5 - Acknowledgement and Assumption of Potential Risk - Voluntary Sports Activity (PDF)
EnglishSpanish

JPA 6 - Acknowledgement & Assumption of Potential Risk - Voluntary Activity (non-student) - (PDF)
English

JPA 14 - Field Trip Driver Form (PDF)
EnglishSpanish

JPA 19 - Playground Equipment (PDF)
English

JPA 21 - Student Excursion & Transportation by Non-District Sponsored Driver/Passenger Agreement (PDF)
English

JPA 24 - Physical Evaluation (PDF)
EnglishSpanish

Property Claim Form (Doc)
English

Property Endorsement (PDF/Doc)
English - PDF
English - DOC

Student Incident Form (PDF)
English

Vehicle Claim Form (Doc)
English

Vehicle Request (PDF/Doc)
English - PDF
English - DOC

Volunteer Registration Form (PDF)
English