Alberta Child Welfare Class Action Lawsuits 2 and 3 Question Title * 1. Please enter your contact information. First Name * Last Name * Address * Address 2 City/Town * Province * Postal Code * Email Address * Phone Number * Question Title * 2. What is your Date of Birth? Date of Birth Date Question Title * 3. Were you in the care of Alberta Child Welfare between 1985 and 2009? Yes No Question Title * 4. What years were you in the care of Child Welfare? before 1965 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Question Title * 5. Did Child Welfare follow all of their legal duties to make a service plan for your family and file it in court? Yes No I don't know Question Title * 6. Do you give me permission to request your records to find out if you might be in the Alberta Child Welfare Service Plan Class Action? Yes No Question Title * 7. Did you suffer abuse while in the care of Child Welfare? Yes No Question Title * 8. What kinds of abuse? sexual physical emotional name calling neglect loss of culture lost relationships with siblngs or extended family Other (please specify) Question Title * 9. Who abused you? foster parents relatives of foster parents friends of foster parents other foster children own parents child welfare worker Other (please specify) Question Title * 10. Do you give me permission to get all of your child welfare information? Yes No Question Title * 11. Do you want to sue Child Welfare? Yes No Question Title * 12. Did you apply for compensation from the Victims of Crime Program? Yes No Question Title * 13. If you applied for compensation from the victims of crime program, how much did you receive? Nothing, I was turned down less than $10,000 $10,000 to $19,999 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 to $69,999 over $70,000 Question Title * 14. How many lawyers have you contacted to help you to sue Child Welfare? none 1 or 2 3 to 5 6 to 10 11 to 20 more than 20 Question Title * 15. How many lawyers are willing to help you sue Alberta Child Welfare on a contingency (percentage) basis? none, no lawyer is willing to help me. 1 to 2 3 to 5 more than 5 Question Title * 16. Provide as much details about your case as you can Done