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Stacy Lane
Director, JPA Services
445-7055
slane@hcoe.org

Taylin Titus
Occupational Safety & Loss Control Specialist
445-7067
ttitus@hcoe.org

Jean Legaz
Administrative Assistant
445-7126
jlegaz@hcoe.org
North Coast Schools' Insurance Group (NCSIG)
Forms

Certificate of Coverage Request (Doc)
English

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

First Aid Incident Form (PDF)
English

First Aid Program Guidelines (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 - Acknowledgment & Assumption of Potential Risk (PDF)
EnglishSpanish

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

JPA 5 - Acknowledgment and Assumption of Potential Risk - Voluntary Sports Activity (PDF)
English

JPA 6 - Acknowledgment & Assumption of Potential Risk - Voluntary Activity (minor) - (PDF)
English

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

JPA 14 - Field Trip Driver Form (PDF)
English | Spanish

JPA 17 - Facility Request Between Member Districts (PDF)
English

JPA 19 - Playground Equipment (PDF)
English

JPA 21(A) - Student Excursion & Transportation by Non-District Sponsored Driver/Passenger Agreement - District Does Provide Transportation (PDF/Doc)
English - PDF | English - DOC

JPA 21(B) - Student Excursion & Transportation by Non-District Sponsored Driver/Passenger Agreement - District Does Not Provide Transportation (PDF/Doc)
English - PDF | English - DOC

JPA 24 - Physical Evaluation (PDF)
English | Spanish

JPA 25 - Post Head Injury/Concussion Initial Return to Participation (PDF)
English

JPA 26 - Homecoming Parade Driver Form (PDF)
English

JPA 27 - Periodic Playground Maintenance Safety Inspection Form(PDF)
English

Property Claim Form (Doc)
English

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

Student Incident Form (PDF)
English

Suspected Child Abulse Report & Instructions (Fillable PDF)
English

Vehicle Claim Form (Doc)
English

Volunteer Registration Form (PDF)
English