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To become a client of Daily Life CK please fill out the form below.
Please make sure you have the correct spelling of names and phone numbers for your emergency contact list. Once you complete your form and submit it, you will be contacted by Daily Life CK. The next step will be setting up a date to start your service and payments. Once you have been contacted and your start date is set you will receive a completed copy of your form. If you have any questions, please feel free to contact us at 907-460-LIFE (5433).
The first Section of the form is your personal information. The second section of the form is the Emergency Contact Information. The Emergency Contacts are who will be contacted to come and check on you in case you are not responding to our calls. The last section of the form is about any pets you own. In the event you would need any medical assistance Daily Life Ck will know who to contact for your pets.
Please be sure to fill in as much information as possible. We would like to know when we should call you. Please indicate AM or PM for phone calls to be made. Calls to Clients will be between 9:00 a.m. to 5:00 p.m. within a 30-minute period of your selected time. If you require a special time outside our regular hours to be contacted, we are willing to discuss it with you. If you have a day, you do not wish to be called, please indicate it on the form.
Please make sure to enter the name and email address of the person completing this form. The email address will be used to send you a completed form once you have a start date and payments set up.
Your form should be submitted once you have it completed. We look forward to Contacting you and getting you started with our service. Thank you for taking the time to review our service and becoming one of our valued Clients.
Daily Life CK call Services Agreement
This AGREEMENT is by and between Daily Life Check (hereinafter referred to as “Daily Life CK), located at 2070 Hattie Creek Road, Fairbanks, AL 99712 and (hereinafter referred to as Client”)
Payment terms:
Monthly calls made daily fee shall be $34.00 per month for daily calls in accordance with the attached terms and conditions.
Term:
The initial term of this monitoring agreement is for one (1) month, and then from month to month thereafter with payment made in advance. Client may terminate this daily call agreement at any time after the initial term with 30 day written notice.
In the event you the client is put on Red Alert and Emergency services is contacted you the Client shall be obligated for and agrees to pay any costs and expenses incurred including, but not limited to, ambulance, physician or other medical assistance in obtaining assistance, or any cost whatsoever incurred as a result of the Client’s use of the Service.
Your personal information will not be shared or sold to any organization as detailed in our privacy policy. Daily Life CK respects your privacy.