Optional Coverage Enrollment Form

To enroll more than one student, please fill out this form again. Seperate payments are required for each student enrollment.

PAYMENT IS NON-REFUNDABLE.
ELECTRONIC PAYMENTS ARE SUBMITTED THROUGH PAYPAL
UNLESS YOU CHOOSE THE PAY BY CHECK OPTION

Optional coverages may be purchased at any time during the school year.
Coverage is non-cancelable and payment will not be pro-rated or refunded for late or discontinued
school enrollment.

Please select to optional coverage desired below and click NEXT to continue.