Intake Form

All fields marked with * are required.

Detained person's first name *

Detained person's middle name

Detained person's last name *

Detained person's suffix

Detained person's date of birth *

Detained person's email *

Detained person's phone *

Prairielands Freedom Fund is committed to resisting the racism inherent in the criminal legal system. We collect race information to ensure that our work does not contribute to or reinforce racial disparity.

Please share how the detained person describes their race. *

Prairielands Freedom Fund recognizes that gendered violence is part of the criminal legal system, and that people who are trans or otherwise gender non-conforming may be particularly vulnerable to harm while detained.

To help us ensure that our work counteracts this inequity, please share the detained person's gender identity. *

Address where detained person will stay

Special concerns could include lack of legal immigration status, pregnancy, homelessness, chemical dependency, any physical or mental health concerns, or any other family/personal circumstances you think we should know about. Also please indicate the person’s primary language, if not English.

Are there any special concerns we should be aware of? *

When was this person arrested?

Where is this person detained? *

Total bail amount *

The detained person consents to Prairielands Freedom Fund posting their bail. *

Name of post-release contact person

Email of post-release contact person

Phone number of post-release contact person

Your name *

What is your relationship to the detained person? *

Your email addess *

Your phone number *

Prairielands Freedom Fund will never disclose information about a person except to the extent necessary to pay bail and facilitate safe release. We may use aggregated data to share our work and expose the inequities of the criminal legal system.

By clicking "Submit", you agree to all of the conditions set forth in the Terms of Use and Privacy Policy