Client Registration Form
The following information is necessary to provide services and all information will be kept confidential. The information needs to be updated each year beginning July 1st. We use the information you provide for statistical summaries required by the City of Berkeley. Your information will be kept confidential and we promise to never share your contact information.
Email *
Date *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This form was created inside of Easy Does It Services.