CrewCare Activation Request

Crew, if you need assistance or have any questions, please visit CrewCare.io/Support and fill out the online help form by clicking the Get Help under Contact Us for Assistance.

One of our team members will contact you as soon as possible.

First Name *Last Name *

Phone *

Please re-enter the phone number below.

Email *Confirm Email *

Address *Address Line 2

City *State *Postal / Zip Code *

Are you over 18? *Gender at Birth *

Date of Birth *Consent *

I give permission to ACTIVATE my CrewCare Benefits. I understand that $60 for the cost of the service will be deducted from my paycheck each month. I have been informed about the service and understand that CrewCare is NOT INSURANCE. I understand that I am not locked into a contract and can cancel the service at any time. I understand that, once activated, my CrewCare benefits provide access to:

• A nationwide network of U.S. Board Certified Doctors 24 hours a day, 365 days a year, in up to 60 languages. Doctors can write prescriptions or a Doctor’s note.

• Discounts on dental procedures, eye care needs, chiropractic, diabetic supplies, imaging, and laboratory services.

• 24/7 availability to speak with Master Level Counselors on issues such as COVID-19 fatigue, death, depression, marriage, relationship issues, substance abuse, financial stress and more.

I understand that because I have activated my CrewCare Healthcare, additionally, the other Free CrewCare benefits will also be activated.

CREWCARE PERKS - LOCAL COUPONS APP
CREWCARE CREDIT-PAL

I understand that these two benefits are free and are provided separately from the CrewCare Healthcare benefits.

I confirm that I am currently employed at McDonald's, and actively working at the store. I am not on a leave of absence.

I confirm that I have been working for more than 2 weeks with at least 10 hours of work completed.

I understand that CrewCare is a month-to-month program with no long-term contract required. I may cancel my participation at any time by visiting the website and completing the cancellation form.

I acknowledge that once my benefits are activated, no refunds will be provided if I choose to cancel or change my mind about participation in the program.

I confirm that I agree to the automatic payroll deduction indicated in the email I received.

I confirm the consent statements above.Submission Date

Signature *