Insurance Registration

    Are you a Canadian citizen?

    Are you currently eligible for your provincial health plan? (ie., OHIP)

    Do you have any pre-existing medical conditions or been diagnosed with any new medical conditions during the last 6 months?

    YOU MAY NOT BE ELIGIBLE FOR TRAVEL INSURANCE. PLEASE EMAIL CLARA@POWERTRAVEL.CA TO DISCUSS IN MORE DETAILS.

    Select your total trip cost:

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    I would like to purchase:

    Note: Coverage WITH Cancel for Any Reason must be purchased within 24 hours of hotel purchase.

    Insurance Package costs are estimates and based on teens traveling to Florida from Ontario. Rates will fluctuate for adults, pre-existing conditions and whether athlete would like to insure the cost of their flights. If your rate is different than the quote provided, you will be advised BEFORE a charge is made.

    Athlete First Name:

    Athlete Last Name:

    Athlete Date of Birth:

    Athlete Email:

    Parent/Guardian First Name:

    Parent/Guardian Last Name:

    Parent/Guardian Email:

    Address:

    City:

    Province / State:

    Country:

    Postal Code / ZIP:

    Phone Number:

    Credit Card Payment Information

    First Name on Credit Card:

    Last Name on Credit Card:

    Credit Card Type:

    Card Number:

    Card Expiration:

    CVV Code: