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Kenosha Community Bail Fund Application
KENOSHA COMMUNITY BAIL FUND
* Indicates required question
Email
*
Your email
Your Name - First Name
*
Your answer
Your Name - Last Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Your relationship to the client?
*
Friend
Family Member
Concerned Citizen
Other:
Client's First Name
*
Your answer
Client's Last Name
*
Your answer
Other Names Used - Maiden/Aliases
*
Your answer
Client's Pronouns
*
She/her/hers
He/him/his
They/them
Required
Client's Race
*
African American
Biracial
Caucasian
Asian
Asian American
Native American
Other:
Required
Does this person identify with the LGBTQIA?
*
Yes
No
Unknown
Any special circumstances/concerns for this client?
*
Your answer
Client's Phone Number
*
Your answer
Client's Email Contact
*
Your answer
Client's Address
*
Your answer
Client's Date of Birth
*
MM
/
DD
/
YYYY
Date of Arrest
*
MM
/
DD
/
YYYY
Bail Amount
*
Your answer
Where Is The Client Being Held
*
Kenosha Pre-Trial Facility (Downtown)
Kenosha County Detention Center (KCDC)
Does The Client Have Any Other Open Cases
*
Yes
No
Is The Client On Probation or Parole
*
Yes
No
Does the Client Have Any Medical Needs
*
Yes
No
Does The Incarcerated Person Consent To Being Bailed Out
*
Yes
No
Is This Person At Imminent Risk Of Housing Loss
*
Yes
No
Is This Person Pregnant
*
Yes
No
Is This Person a Survivor Of Domestic Violence? Is Their Arrest Related To Their Survival
*
Yes
No
Does the Incarcerated Person Speak English? If Not, Please List Their Primary Language So We Can Accommodate Them
*
Yes
No
Other:
Will the person need a ride upon release?
*
Yes
No
Submit
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