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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. Were you abused or injured while in the care of Alberta Child Welfare?

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* 4. Do you have a child or children or family member that was abused or injured while in the care of Alberta Child Welfare?

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* 5. What are the names of your children and their dates of birth?

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* 6. What years were you or your children in the care of Child Welfare?

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* 7. Who abused or injured you or your children?

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* 8. What types of abuse or injury did you suffer?

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* 9. Mark all that apply to you?

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* 10. Do you want to sue Child Welfare?

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* 11. Do you give me permission to get  your child welfare records? 

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

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* 13. Will you contact at least 20 lawyers to try to find a lawyer that will take your case on a percentage?

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* 14. After you have contacted 20 lawyers, will you complete questionnaire #3 "Can you find a lawyer to represent you?"

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