Become a Client Registration

Become a Client Registration

Complete this form once to register as a client. Use CCC Pet Care App for direct bookings. Provide your primary email for important app updates.
Client Active

ActiveInactive
📆 Today's Date

MonthDayYear
Todays Date
First Name*
First Name
Last Name*
Last Name
📱 Cell Phone*

Area CodeCell Phone
📧 Email*
Best Email to reach you at.
🏡 Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
🏙 What District/Neighbourhood do you live in?*
🏡📠 Home Phone

Area CodeHome Phone
👩🏻‍💻 Work Phone

Area CodeWork Phone
🌟What services are you interested in? Please choose one.🌟*

Pet SittingHouse Only no pets (Home Security Checks)Overnight Pet SittingDog Let Out (potty break and fresh air)Puppy Play Time (3 visits/day)Nursing Pet Care (Insulin. PostOp Care, SubQ Fluids)Disease Management (Renal Failure, Diabetes)Pet + Home Enrichment AssessmentConcierge (cut lawn, snow removal, etc)Senior Pet EducationOther
🌟 What species of pets do you own?🌟 Choose one or more.*

CatDogBearded DragonBirdChinchillaDeguFerretGerbilGuinea PigHamsterHedge HogHermit CrabIguanaMiceRabbitSnakeSugar GliderTurtles & TortiousNone - I have no animalsOther
🐶😺🐭🐹🐰🐸🐠🦜 How many animals do you have? For each pet, please provide their names, species, color, sex, age, and indicate if they require any medical care (such as insulin, SubQ fluids, etc)*
Please provide as much details as possible.
🌞 Please specify the day you would like our services to START.*

MonthDayYear
Date of Departure - Start Date
☀☀ Please tell us the day you would like our services to END.*

MonthDayYear
Date of Return - End Date
🛫 How many visits are needed on the date of departure?*
Visits to Start
🏖 How many visits are needed on the days in between?*
Visits in between
🛬 How many visits are needed on the date of return?*
Visits End
👩‍🌾 Will you be sharing home or pet care responsibilities with anyone else not affiliated with our company during your absence? If yes, please provide details of the job-sharing arrangement. Learn more... https://corkscrittercare.com/policy-and-terms-of-use/*
Petcare 3rd Party
👂🏻 How did you hear about Corks Critter Care? (If from a friend or acquaintance, please provide details in the next field).

Business CardWord Of Mouth / Referral (Friend-Family-Neighbor-Co Worker)InternetPinterestFacebookWebsiteGoogleVet Clinic StaffVeterinarianPet StoreGroomerCouponAnother Pet Sitting BusinessAnother Dog Walking BusinessOther
📢What is the person's name and email who referred you to us? Tell a friend about us and you both get $25 coupon code off your next invoice. Earn unlimited credits! Both get an email with a coupon code to enter in your next invoice.
Name and email of who referred you to us
💰 Earn unlimited $$ credits! Go to our website ⇾ Rewards/Referral Program
📝 Do you have any additional comments or special requirements?
Additional Comments
🎫 Please provide your Gift Certificate Code or Coupon Code for the discount.
Gift Certificate Code/Coupon Code
Thank you for contacting Corks Critter Care. Once you submit, your request is received, and we will contact you during business hours within 24 hours. If you have a preferred time and day to phone you please to let us know by using this link -> CorkWillCallYou.

Are ready to meet us and set up a customized pet and home care plan? Choose the following Orientation Initial Visit link below and click to book an convenient day and time. >^..^<

In-Person Orientation Initial Visit ($20 fee)
Please visit Corks Critter Care Policy and Terms of Use to familarize yourself with our policies.
✔ I agree with Corks Critter Care terms & conditions, and they can be found on website: https://corkscrittercare.com/policy-and-terms-of-use/*

Yes, I agreeNo, I don't agree
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