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INTAKE FOR CLAIMS AGAINST KERN HIGH SCHOOL DISTRICT (“KHSD”)

Claims Intake

Date

Name

Phone Number

Address

City

State/Province

Zip/Postal

Country

Email Address

Employer

Have you ever applied for employment with or been employed by KHSD?

Yes

No

If yes, approximate time period:

Have you ever volunteered with KHSD, such as athletic coach, volunteer coach, etc.?

Yes

No

If yes, approximate time period:

Have you (or your child) ever applied for or have received an inner-district transfer?

Yes

No

If yes, approximate time period:

If yes, do you believe you were “targeted” by anyone from KHSD?

Yes

No

If yes, briefly explain:

For each category above, were you ever asked for permission to run a background check?

Yes

No

If yes, were you given an authorization form to sign?

Yes

No

If yes, do you have a copy of the authorization?

Yes

No

If there is a lawsuit filed against KHSD for violations of privacy or constitutional rights, do you want to be notified?

Yes

No

If your rights were violated by KHSD, would you like to be represented in a lawsuit brought to right those wrongs?

Yes

No

Any Additional Details?

WARNING: information sent to the law firm and its attorneys is not confidential and specific details of your case should not be sent via this form. Please provide general information only. Sending information and an enquiry to the law firm and its attorneys does not create an attorney-client relationship and no work will be performed on your case unless the firm agrees to a formal attorney-client relationship.