Welcome to Child Care Insurance Specialists

“Providing insurance specifically designed for military child care for over 25 years”

Welcome to our new site! NEW PROVIDERS or RENEWALS – Use the form below to sign up and create your account. A certificate will be immediately emailed to you upon completion.

Army providers are generally serviced under Air Force supervision unless otherwise instructed.”

YOUR INFORMATION
Branch of Military:  Air Force
 Coast Guard
 Marine Corps
 Navy
First name: Last name:
Street:
Street 2:
City: State:
Zip:
Phone:

Email (Username):
Password:
Password (confirm):

Do you have pets?  Yes          No
Pets details:

Have you had previous losses?  Yes          No
Previous Losses details:

SPONSOR DETAILS
First name: Last name:
Rank:
Last four digits of SSN:

DIRECTOR DETAILS
First name: Last name:
Email:

POLICY DETAILS
Effective Date:
Length:  6 Months
Cost: $
0.00

PAYMENT DETAILS
Name on Card:
Card Number:
Expiration Date: / MM/YYYY
Security Number:
Billing address same as shipping address
Street:
Street 2:
City: State:
Zip:

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