Children360 Insurance Inquiry Form

Welcome! Please fill out this form to learn more about the Children360 insurance plan or to request a consultation. Our team will be in touch with you shortly.

Application - Children360 Insurance

Personal Information

First Name

Last Name

Relationship to Child

Your Children's Information

How many children do you have?

Please list the ages of your children.

Does the child have any pre-existing medical conditions?

Yes

No

If yes, please specify:

Insurance Inquiry Details

Type of coverage interested in:

Life Insurance

Critical Illness

Both

Do you have any current insurance policies for the child?

Yes

No

If yes, please specify:

Location of Coverage

What's Your Address?

I agree to Square Credit's Privacy Statement and CASL (Canada's Anti-Spam Legislation).

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Children360 Insurance Inquiry Form

Personal Information

Your Children's Information

Insurance Inquiry Details

Location of Coverage