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Travel Insurance
Traveler Information
*Name of Primary Traveler:
*School or Organization:
*Teacher/Sponsor of Trip:
*Address Line 1:
Address Line 2:Apt. or Suite No.
*City:
*State:
*Zip Code:
*Phone:
*Destination of Trip:
*E-Mail of Parent:
*List all travelers` LEGAL NAMES, DOB, & GENDER:
Comments:
Information on the insurance can be found by clicking the link above.

The cost of the insurance depends on the cost of the trip and the age of the traveler.

EXAMPLE: If you are looking at the link above, a student that is 14 years old with a trip cost of $720, would pay $52 for the insurance.

Someone that is 52 years old with a cost trip of $1450 would pay $87 for the insurance.

Children under the age of 21 are covered at no additional cost when accompanied by a covered adult family member; limit 1 child per 1 adult.

If you or your child has a pre-existing condition that would keep them from traveling on the trip, the insurance would need to be purchased 14 days from the first deposit.

If there are no pre-existing conditions, the insurance can be purchased up to 48 hours before the trip.
Credit/Debit Card Information
*Amount to charge today:
See the picture for pricing.
*Card Number:Please put dashes between sets
*Name on Card:
*Expiration Month:
*Expiration Year:
*Card Brand:
By submitting this form, you are agreeing to all terms and conditions and no money is refundable or transferable.
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