Hamilton Community Legal Clinic (HCLC) Intake Form for COVID-19 Offences and Incidents
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Date
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Name
Home address or shelter information
Contact information (e.g. phone number, email address)
To which age group do you belong to?
To which racial group do you belong, or do other people sometimes believe that you belong to?
Which gender identity do you most identify with?
Which gender expression do you most identify with?
Do you belong to a religious group? Please identify the group below.
Do you identify as a person with a physical disability or disabilities?
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Please state any mental health barriers you may have.
Are you involved in substance use?
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Are there any other aspects to your situation that you think may be relevant (e.g. immigration status and homelessness)?
When were you charged?
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Where were you charged? (City, Province)
What were you charged with?
Did you receive a ticket, fine and/or a penalty?
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Who gave you the ticket, fine and/or penalty?
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Were you given any kind of warning before being charged? Please explain.
Tell us about your encounter with the police/by-law officer. What happened?
Have you ever been charged or ticketed for another COVID-19 related offence? Please tell us the number of times and circumstances.
Would you like to receive free legal advice on your legal options?
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Submit
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