Report Child Abuse or Neglect

Preventing and reporting child abuse and neglect is one of the most important things a community can do for its children. Please complete the following information the best you can to protect a child and get help for a family.

Mother's First Name

Mother's Last Name

Mother’s D.O.B/Age

Mother's Address

Mother's Phone Number

Father's First Name

Father's Last Name

Father's D.O.B/Age

Father's Address

Father's Phone Number

Children(s) Name/ DOB/Age

Allegations

Perpetrator’s Name/DOB/Age

Perpetrator’s Address

Perpetrator’s Phone Number

Your Contact Information

Providing your contact info will help us follow up in case we have questions to assist in our investigation. Your identity will remain anonymous.

First Name

Last Name

Phone Number

Email Address

Relationship to family/child

If a mandated reporter please include the name of your Organization and position.

Is it safe to contact you?

Yes

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