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Book DuckDuck
Quack & Tell Program
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Quack & Tell Program Application
Help + honk= honest feedback
Apply for the Quack & Tell Program
First name
(Required)
Last name
(Required)
Email
(Required)
Phone
(Required)
Service address
(Required)
Are you applying for yourself or a loved one?
(Required)
What's your preferred method of communication?
Text
Email
Call
Doesn't matter
Which activities would you like DuckDuck to accomplish during your appointment?
(Required)
Errands (like pharmacy pick-up, get groceries)
Household tasks (like tidying up, meal prep, pet care)
Companionship (like chatting, read to you)
Activity (like memory book, scavenger hunt, go for a walk)
Something else
If you marked "something else", please describe in the box below.
Anything else we should know about who we're helping or the service site?
We typically work weekday evenings (6-8 pm) and weekends, but we can make weekdays work with advanced notice. Please list a few dates and times that work for you.
(Required)
Can we count on you for feedback to improve DuckDuck and your photo for our materials?
(Required)
Yes to all! (Providing honest feedback, leaving a public review, and having my photo taken.)
Yes to providing honest feedback.
Yes to leaving a public review.
Yes to having my photo taken.
None
How did you hear about the Quack & Tell Program?
(Required)
Social media
Referral
Internet search
DuckDuck website
Other
Apply
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