Court Patrol
Name*:
Age:
Email Address*:
Zip Code:
Borough*:
Telephone No.:
What borough is your family case in?
Bronx
Brooklyn
Manhattan
Queens
Staten Island
What is your child's name?
How old is your child?
No
Yes
Is your child in foster care?
If so, how long?
What foster care agency?
Has your child been injured in foster care?
No
Yes
Has your child been stolen away from you?
Yes
No
If yes, by who?
Mother
Father
ACS
Grandma
Grandpa
Relative
Other
Who is the law guardian on the family case?
How many times have the law guardian met with your child?
Who is the psychologist on the case?
Who is the judge on your case?
Who is your attorney?
Are you representing yourself?
Yes
No
Do you feel that your civil rights are being violated?
Yes
No
Did a judge transfer your case?
Yes
No
Are there allegations of abuse against you or any family members?
Yes
No
Emotional
Mental
Neglect
Physical
Psychological
Sexual
If yes, what are they?
When is your next court case?
Comment: (20 words or less please)
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