Name
*
First Name
Last Name
Email Address
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
May we contact you at this phone number and address about your legal issue?
Are you married?
How Many Children to you have?
If yes, how many children do you have?
What age are your children?
Do the children live with you?
If NO, where do the children live?
Do you support the children financially?
Are you employed?
This does not affect eligibility for services at this clinic.
Because we have more requests for help than we can meet, we must prioritize our services for those IN the most need.
How did you hear about the clinic?
What is your legal issue:
Explain
County/State of Legal Issue
Have you consulted an attorney about this matter?
Do you have any other legal matters at this time? If so please explain
Conflict Check We perform a conflict check before your appointment to make sure we have not previously met with your spouse, ex-spouse or an opposing party about your legal issue. We do this to protect your confidentiality. If your matter is a conflict with a person or organization, name the opposing party:
Do yo attend a church?
If yes, what is the name of your church and your Pastor/Bishop/Priest?
Client Acknowledgement Legal Clinic offers you a short meeting with an attorney, free of charge, to discuss a legal matter. The volunteer attorneys can provide information on most legal matters along with brief advice about the next steps you may wish to take. I understand and agree to the following: 1) The attorneys staffing this clinic are volunteers; 2) The volunteer attorneys are not acting as my attorney; 3) The volunteer attorneys I meet with today will not give me brief legal advice, but will provide me with information; 4) The volunteer attorneys are not conducting a private consultation; 5) Participant remain responsible for all parts of my case; 6) The party on the other side may now or in the future be represented by this attorney’s law firm; 7) What participant tell the attorney today is confidential, although my information can be shared with others in a good faith effort to assist me in this matter; 8) The clinic may decline to help with any reason including: a) Legal problem(s) is beyond the scope of the clinic’s services; b) Volunteer attorney believe he or she has already helped participant as much as he/she can with the legal matter; c) Participant’s behavior is disruptive, abusive or violent; d) Participant’s visit to clinic become too frequent and take up more time than is fair to other users; or e) Request for advice or service conflicts with any provision of the California Rules of Professional Conduct. 9) New Direction Community Legal Clinic does not make legal referrals. It is everyone’s responsibility to make an informed decision in seeking legal or other professional advice. Contact the California Bar Association for referrals; 10) Participant agrees not to hold New Direction Community Church and/or the participating volunteer attorneys liable for any advice they receive during the clinic which is not to his or her liking, or is based upon inaccurate and/or omitted facts. Participant also acknowledges that the legal clinic is being held for the purpose of addressing simple legal questions.
By typing your FIRST and LAST name you acknowledge the signature of this document and the above information is correct.
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