Beta Tester Enrollment Application

Beta User Enrollment Application

Thank you for your interest in the Keep Safe 911 Beta User Program. Please complete the questionnaire below to be considered.
Applicant information
Applicants Name*

First NameLast Name
Date of Birth - must be over 18 years old*

MonthDayYear
Date
Age
Email*
example@example.com
Primary Phone Number*
What best describes you?*

I'm a parentI'm an uncle/auntI'm a grandparentI'm a foster parentOther
Are you available on Thursday, April 27, 2023 at 6pm?*

YesNo
What social media platform(s) are you currently most active on?*

ClubhouseFacebookInstagramLinkedInSnapchatTik TokTwitterWeiboYouTubeOther
Please share your social media handle(s).
What's your biggest safety concern with the children in your family?*

Ability to helpBullyingRacial disparity/inequalitySafety issues at schoolStranger dangerTraffickingOther
How did you hear about us?*
Your equipment and software
Do you have access to an android or apple phone for testing purposes?*

YesNo
What phone model do you have?
Your technical abilities
How confident are you using your phone (ex: screen captures, manage Google play store and app settings)?*

1

2

3

4

5

6

7

8

9

10

1 is Not confident, 10 is Very confident
Do you have any previous experience as a beta tester?

YesNo
Beta tester requirements
All beta testers will be required to download the Keep Safe 911 app on their phone - promo code for a one month subscription will be provided. Do you agree to this term?*

YesNo
All beta testers are required to attend the full Beta session. In exchange, a $10 gift card will be rewarded to all approved testers. Do you agree to these terms?*

YesNo
All beta testers will be required to sign an NDA. Do you agree to this term?*

YesNo
All beta testers will be required to send feedback and bug reports promptly throughout the beta program. Do you agree to this term?*

YesNo
By signing below, I acknowledge the agreement stated in this form. I also confirm that all information I entered in this form is true and accurate.
Applicant Signature*

Clear
Date Signed*

MonthDayYear
Date
Hour Minutes
Should be Empty:

Beta User Enrollment Application

Applicant information

Your equipment and software

Your technical abilities

Beta tester requirements