Pacific Lutheran University Individual Primary Sports Enrollment Form

Pacific Lutheran University requires that you carry primary insurance while you are playing intercollegiate sports. If you do not have primary insurance you will be required to sign up for the Individual Sports Plan. The coverage will not be pro-rated and refunds will not be given once you have practiced or played.
Student ID Number * Required
First Name * Required
Last Name * Required
Gender * Required
Address * Required
Street Address Address Line 2 City State ZIP Code
Phone * Required
Email * Required
Date of Birth * Required
Sport(s) participating in * Required
Athletic Enrollment Agreement Policy * Required
- Price: $805 for $5,000 in coverage
By checking the box above I acknowledge that I wish to enroll in the Individual Sports Plan for the 2024-25 policy year. I understand the premium cannot be pro-rated and will be billed to my school account. Once I have participated in a practice or game there will not be any refunds or premium if I discontinue play.