Request for help by a minor currently under the care or supervison of a child protection agency

Enter your personal information. Help cannot be provided without proper disclosure of information and how we may contact you. Information will be kept confidential.

Check one of the check boxes below which best describes your current living arrangements.

Provide information about the child protection agency that you are either living in the care of or under the supervision of

To help Canada Court Watch better understand the problems you may be experiencing, check off all the boxes below which you feel are applicable. You may also write your own comments about some of the problems you are experiencing in the text box provided.

If you feel that you are experiencing problems with any particular workers then indicate their names and below their names describe the problems you are are having with each worker. Spaces have been provide for the names of two workers. We will cross reference the names of the workers in our national database of child protection workers to see if there have been other complaints against the same workers.

Provide information below to indicate as to how Canada Court Watch can contact you or someone you trust (such as a family member) through one of the two options given below. At least one email address or phone number must be provided. If you cannot be contacted where you are living then indicate in the alternate contact information below.

If you have any comments or suggestions which you feel might improve this form, then please indicate your comments below