GSSDA Insurance Program For Clubs and Dancers


Protection Includes Accident & Liability Coverage

Although safety rules are closely followed, accidents will happen. Accident Medical insurance helps protect club members from financial loss due to a covered accidental bodily injury. Liability insurance protects the club and its members and association officials from financial loss due to unforeseen incidents which may develop into litigation against members and dance organizations.


Eligibility, Premium & Policy Term

Dancers of GSSDA member clubs are eligible for USDA insurance at the current price rate of $4.75 per person per year with a minimum rate of $45.00 per club. 100% of club members must be covered by this policy for it to become effective. The insurance policy runs from January 1st to December 31st. People belonging to more than one club need to pay only one fee and will be covered while dancing at any other club sponsored dance. This policy does not cover callers/cuers or their equipment when they are calling/cueing. The policy does cover callers/cuers if they are dancing to another caller/cuer and they are included on the club roster and the club member rate has been paid. A summary of coverage can be viewed at USDA.org.


Instructions For Obtaining Coverage

  1. A copy of GSSDA membership payment along with required membership documents, club dance information and a check for insurance ($4.75/per person or a minimum of $45.00), must be sent to the GSSDA Insurance Chairmen at the following address:
    Jim & Cathy Meeker
    116 Fontaine Walk
    Warner Robins, GA 31088
  2. Send two copies of the club membership list with 100% of the club members listed in alphabetical order with the address and phone number of each member. Include names of club President and Insurance Coordinators. E-Mail addresses would be helpful for these members.

  3. Three copies of the following forms are also required. They can be found at USDA.org or by clicking on the links below.

    • Federation Or Association Club Listing Form [Click for PDF]
      • On this form, the From information for the Federation should read as follows:
      • Name of Association: GA State Square Dancers Association
      • Name of Insurance Chairman: Jim & Cathy Meeker
      • Address of Insurance Chairman:
             116 Fontaine Walk
             Warner Robins, GA 31088
      • Phone Number of Insurance Chairman: 478-224-8986
      • On this form, the information for the Club should include the following:
      • Club Name
      • C/O Members name and the address to where the policy should be sent
      • Total number of members
      • Regular dance nights (i.e. 1st & 3rd Saturday, 8-11 p.m.)
      • Location of the facility being used for dances (please use the 911 address). Include on the form any special dances, exhibitions, or demonstrations such as nursing homes, malls, churches, etc. If teh owner of a building or facility where you will be dancing requires coverage you must furnish their complete name and address.
    • Club Roster Enrollment For The Year Form[Click for PDF]
      • Please list members in alphabetical order.
      • You must sign at the bottom of the form. This is a requirement of the insurance company and the form will be returned if not signed.

    • Club Roster Dancers Insured Through Another Club Enrollment For The Year Form[Click for PDF]
      • Please list members in alphabetical order and the name of the club they are insured through.

    • Club Sponsored Class Form [Click for PDF]
      • To ensure coverage for the class members you must complete this form.
      • List each class member's name and the insured club they are associated with and send to the GSSDA Insurance Chairman at the address noted above.
      • Class members are automatically covered as a part of an insured club . with no additional cost with a time limit of 9 months.

    • Additional Enrollment Form [Click for PDF]
      • This form must be submitted when a new member(s) joins a club after the Club Roster Enrollment For The Year form has been submitted.
      • The form along with the insurance fee for each member listed on the form must be sent to the GSSDA Insurance Chairman at the address noted above.

    • Accident Report Form [Click for PDF]
      • This form must be completed and submitted to the GSSDA Insurance Chairman at the address noted below within 48 hours of an accident.
      • Upon receipt of this accident report a claim form will be mailed to the club.



Your cooperation concerning insurance is greatly appreciated and if you have questions the contact information for the GSSDA Insurance Chairmen is noted below:
Jim & Cathy Meeker
116 Fontaine Walk
Warner Robins, GA 31088
Phone: 478-224-8986
Email: catjim3@aol.com

Last updated: March 27, 2016