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Welcome to the Defenders of Children intake application. Filling out this form is the first step in seeing if you are eligible to receive legal services. This information will be kept confidential. If you have any questions or concerns, please contact our office at (602) 710-1903. Thank you!

Intake Form

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Email Address(Required)

Phone Number(Required)

Gender Identity

Pronouns

Race/Ethnicity

Black/African American

Latino/Hispanic

White

Asian

Native American

Multiracial

Other

How did you hear about us?

Referring Agency(Required)

Referring Advocate or Case Manager(Required)

Legal Intake Form

PLEASE NOTE: All information provided to Defenders of Children through this initial intake form will be kept strictly confidential by Defenders of Children. However, simply completing and submitting this initial intake form will not establish an attorney-client relationship between you and Defenders of Children. By completing and submitting this initial intake form, you are applying for legal assistance from Defenders of Children, not retaining Defenders of Children to assist you.

In what legal area(s) do you want assistance?(Required)

Crime Victim Rights

Protective Order

Family Law/Custody

Emancipation/Termination

Consumer Law

Landlord/Tenant Law

Education Law

Employment Law

Child Educational Advocacy

Unsure

Description of legal situation or services requested(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your address protected?

May we leave a voicemail if we call your phone?

Your relationship to the child(ren)(Required)

Child(ren)'s names and DOB(Required)

Please list the child(ren)'s name and dates of birth.

Current custody status(Required)

Do you have an attorney?

Attorney's name (if applicable)

Opposing Party's Information

Opposing party's (OP) full legal name(Required)

OP's date of birth(Required)

MM slash DD slash YYYY

OP's address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

OP's phone number

OP's email

OP's current or last known employer

OP's relationship to you

OP's relationship to child(ren)

Does OP have a criminal/domestic violence history?

If so, explain

Does OP have an attorney?

OP's attorney name, if applicable

Department of Child Safety (DCS) and Law Enforcement Information

Is DCS currently investigating?(Required)

Have you contacted the police? If so, which department?

Is there a current court case?(Required)

City/County

Case Number

Is there a current Order of Protection?

Do you have ECR?

Maricopa County only

If so, please provide the username and password

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By submitting this form, you are consenting to receive marketing emails from: Defenders of Children, 2700 N. Central Ave., Ste. 1100, Phoenix, AZ, 85004, http://DEFENDERSOFCHILDREN.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email.