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Kansha.care - Interest Form

Who are you signing up for?

Who are you signing up for?
A
B
C
D

City where service is required?

Your Name

Your Phone Number

Your Email

Would you like to participate in the pilot?

Would you like to participate in the pilot?
A
B
C

Are you comfortable participating as an early user? Some features are evolving and feedback is actively sought

Are you comfortable participating as an early user? Some features are evolving and feedback is actively sought
A
B

Are there specific concerns with regards to your parents' safety that we should address?