Details of Individual Lawsuit 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 abused or injured while in the care of Alberta Child Welfare? Yes No Question Title * 4. Do you have a child or children or family member that was abused or injured while in the care of Alberta Child Welfare? Yes No Question Title * 5. What are the names of your children and their dates of birth? oldest next youngest next youngest next youngest next youngest next youngest Question Title * 6. What years were you or your children in the care of Child Welfare? before 1960 1960 1961 1963 1964 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 Question Title * 7. Who abused or injured you or your children? a child welfare worker a group home worker a receiving home a foster parent a friend or relative of a foster parent a family member Other (please specify) Question Title * 8. What types of abuse or injury did you suffer? sexual abuse physical abuse emotional abuse name calling neglect car accident Other (please specify) Question Title * 9. Mark all that apply to you? child welfare should not have removed me from my family child welfare should have removed me from my family but did not remove me fast enough or at all child welfare returned me to my family when they should not have child welfare did not take care of me properly after they removed me from my family. I was abused after I was removed from my family I lost contact with my siblings after I was removed from my family I lost contact with my parents after I was removed from my family I lost contact with my extended family (aunts and uncles and grandparents and cousins) after I was removed from my family I had no stability after I was removed from my family I was moved too many times after I was removed from my family I barely knew who my child welfare worker was and did not have a trusting relationship with my child welfare worker my foster parents did not care about me my foster parents were mean to me my child welfare worker did not care about me I told child welfare that I was being mistreated or abused by my foster family and child welfare did nothing to protect me I told police that I was being mistreated or abused by my foster family and the police did nothing to protect me I told other people that I was being mistreated or abused by my foster family and nothing happened to protect me child welfare should not have removed my children from me child welfare did not help me and give me services so that I could keep my children child welfare workers were mean to me and were not helpful child welfare workers did not explain things to me in a way that I could understand I told child welfare that my children were being mistreated or abused by their foster parents, but child welfare did nothing to protect my children my lawyer did not do a good job for me my child's lawyer did not do a good job for my child Question Title * 10. Do you want to sue Child Welfare? Yes No Question Title * 11. Do you give me permission to get your child welfare records? Yes No Question Title * 12. Describe what happened to you and explain what Child Welfare did wrong that makes you want to sue them. Question Title * 13. Will you contact at least 20 lawyers to try to find a lawyer that will take your case on a percentage? Yes No Question Title * 14. After you have contacted 20 lawyers, will you complete questionnaire #3 "Can you find a lawyer to represent you?" Yes No Done