Black Friday Blessing Sale
Registration Form
Black Friday Blessing Sale
Welcome to the Black Friday Blessing Sale with Destiny’s Caring Hands LLC. This special offer allows new families to experience the Extra Agency for only $45, receiving one of the following: 3 Hours of Non-Medical Personal Care, or 4 One-Way Transportation Rides. We created this sale because care should be affordable for every family. We’re the Extra Agency — Extra Mile. Extra Care. No Extra Cost. Please complete the registration below. Our team will contact you to finalize payment and secure your appointment or ride schedule.
Section 1: Contact Information
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section 2: Who Is the Service For?
Who will receive the service?
Age of Individual Receiving Service?
(Must be age 5 or older)
Section 3: Choose Your Black Friday Blessing
Which Black Friday special are you registering for?
3 Hours of Care for $45
4 One-Way Transportation Rides for $45
Section 4: Select the Service You Need
Select the service you need:
Select the service you need
Please Select
Attendant Care (ATTC)
Homemaker Services (HMK)
Respite Care (RSP)
Companion Care
Personal Care
Bathing / Grooming Assistance
Meal Preparation
Medication Reminders (Non-Medical)
Light Housekeeping
Deep Cleaning (Add-On)
Laundry Services
Mobility Assistance
Safety Supervision
Transportation – One-Way
Transportation – Round Trip
School Transportation
Work Transportation
Errands & Shopping Support
Child Wellness Check-In (Ages 5+)
Adult Wellness Check-In
IHCC Visit (LPN/RN)
Appointment Advocacy (Non-Medical)
Home-Delivered Meals
Community Engagement / Outings
Structured Family Caregiving Support
End-of-Life Care (Non-Medical)
Alzheimer’s & Dementia Support
Medication Pickup / Dropoff
File Organization / Paperwork Support
Gift Wrapping
Other (Please Specify Below)
If you selected “Other,” please describe below:
Section 5: Service Preferences
Preferred Time of Day
Please Select
Morning (7 AM – 12 PM)
Afternoon (12 PM – 5 PM)
Evening (5 PM – 8 PM)
Flexible
Describe the support you need (optional)
SECTION 6: Payment Agreement
To secure your Black Friday Blessing Sale spot, payment of $45 is required after our team contacts you. This sale is limited to the first 50 families and must be used by December 31, 2025.
Please check to acknowledge and agree:
I understand payment must be made in full to secure my spot.
I understand this offer is limited to the first 50 families.
I understand all services must be completed before December 31, 2025.
SECTION 7: Final Details
How did you hear about this sale?
Please Select
Facebook
TikTok
Website
Family / Friend
Referral
Event
Other (Short Text)
Additional Notes (Optional)
Signature
Date
Claim My Black Friday Blessing
Should be Empty: