The following form is provided to you for making changes or requests on your existing policies. By submitting this form you understand that no coverage or premium adjustment of any kind is bound until you receive written notice from us.

Policy Change Request

* indicates required fields
This field is required.
This field is required.
This field is required.
This field is required.

Current Insurance Information

This field is required.
This field is required.
This field is required.
This field is required.
By checking this box, I consent to receive informational SMS messages from The Lifeguard Insurance at the phone number provided. These messages may include appointment reminders, policy updates, and customer support communications. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for assistance. Consent is not a condition of purchase. SMS consent is specific to and is not shared with or sold to third parties or other insurance agents.
This field is required.