Roblox Abuse Pre-Qualification Form

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Was the child under 18 at the time of the abuse?

Yes

No

Did the child meet the abuser through the Roblox platform?

Yes

No

What type of harm occurred? (select all that apply)

Grooming (an adult building trust with the child to get them to do inappropriate things)

Sexual exploitation (inappropriate pictures, sexual messages, or asking the child to send photos/videos)

In-person contact (the abuser met the child in person)

Did the child receive psychiatric or psychological treatment as a result of the abuse?

Yes

No

Are you currently represented by an attorney for this matter, or have you previously worked with an attorney regarding this claim?

Yes

No

I confirm that all information provided is truthful and accurate. I understand that my claim will require verification through medical records, identification, and any other supporting documentation. Providing false information will result in immediate disqualification.

I consent to being contacted by Poca Lead Logic by phone, email, or text regarding my potential case.

Your Child Logged On to Play a Game. What Happened Next Shouldn’t Have.