• Intake Form

    Protests Los Angeles

  • Instructions: Please fill out this form. Once you have completed the intake, review your answers before clicking submit.

    If you have any questions regarding the intake process, please reach out to Weston Rowland at rowlandweston@gmail.com

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  • Basic information (1 of 6)

  • Preferred Gender Pronouns
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  • Format: (000) 000-0000.
  • What is your immigration status?*

  • Information about arrest and citation (2 of 6)

  • Were you arrested ?*
  • Have you been arrested before this arrest?
  • Were you arrested for a curfew violation?
  • Were you were advised or told about the curfew prior to arrest?
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  • Were others arrested with you?

  • Police crowd management (3 of 6)

  • Was there a dispersal order (police announce to protesters that there has been an unlawful assembly declared and that the protesters need to vacate a specific area within a specific amount of time)?
  • Please check all that apply:
  • Did the police surround the group from one or more sides in an attempt to push the group?
  • Were people free to leave the area if they wanted to?
  • Did the police proceed to arrest protestors one-by-one?

  • Handcuffs and conditions of confinement (4 of 6)

    For purposes of this form, "handcuffs" includes both metal and plastic handcuffs (aka zip-ties or flexi-cuffs).
  • Were you put in handcuffs?
  • Where were your handcuffs?
  • Where the cuffs metal or plastic?
  • Until
  • Did you ask the police officer to loosen the handcuffs?
  • Were you given access to a restroom and water while detained?

  • Abuse by police and injuries (5 of 6)

  • Please select if the interviewee was subjected to any of the following use of force by the police:
  • What area of your body was injured
  • Do you have any photographs or videos of your injury?
  • Did you get medical care to treat your injuries?
  • Do you have documentation of the medical care you received?
  • Is your injury ongoing?

  • Final questions (6 of 6)

  • Thank you for filling out the intake.

    If neccesary we will be in touch We are proud to support you and the other protesters. You’ll be hearing from us again soon.  If you have any questions about the intake process please contact Weston Rowland at rowlandweston@gmail.com

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