Parkville Youth Justice Precinct Class Action

1. Personal Details

Full name

First NameLast Name

Date of birth

Date

Email address

example@example.com

Phone number

Current address

Street Address

Street Address Line 2

CityState

PostcodeCountry

2. Institutional History

Were you admitted to any of the following institutions?

What approximate year or years were you admitted?

How old were you when you were first admitted?

3. Your Experiences

While at Parkville, did you experience any of the following?

Are you able to identify the person or people responsible?

Please provide any names, nicknames, roles, or descriptions you remember. You do not need to be certain, any details may assist.

4. Consent & Privacy

Your personal information is collected by Angela Sdrinis for the purpose of this proceeding and handled in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles.

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