Online Application
Step 1 of 3: Enter Insured Information
Include all family members to be insured on this form.
Manitoba
students and parents please refer to
Manitoba Student Accident Insurance
for a description of plans and benefits for Manitoba.
Click here to view plan details.
Where did you hear about insuremykids®?
Child's School
IMK Brochure
Email from IMK
Word of Mouth
Facebook
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(optional)
Please Specify:
Start Date :
(dd-mm-yyyy)
Province
School Board
Multi-year Option
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1 year
3 years
5 years
The 3 and 5 year rates can save you 5% and 10% respectively.
Date of Birth
First Name
Last Name
YYYY
MM
DD
School Name
Plan
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Optional Coverage
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choose plan ...
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*
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
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*
*
*
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
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*
*
*
choose school ...
(Other)
choose plan ...
Platinum Plan
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