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* 1. Please enter your contact information.

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* 2. What is your Date of Birth?

Date of Birth

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* 3. Are you able to pay all disbursements and an hourly fee of $300/hour plus a contingency fee of 10% at the end of the case?

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* 4. Are you able to provide a retainer of $10,000.00?

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* 5. Describe what happened to you and explain what Child Welfare did wrong that makes you want to sue them.

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* 6. When did the event that you want to sue for occur?

Date of Birth

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