Declaration
Conyers School, our insurers, service providers, agents and business partners may contact anyone who can give them information relevant to my claim. I confirm that the information I provide is true and if any of the information given by me (or anyone on my behalf) is incorrect, I agree that such inaccuracy may cause me to forfeit my rights under the policy.
Where a representative of the student is completing this form, the representative confirms they have the authority to act on behalf of the student.