Your Name?

Name of child? name

Your Relationship to the child? Custodial Parent Family Friend Law Enforcement P. I.

If not the Custodial Parent name of Custodial?
How can we contact them? Email Phone

Type of disappearance?

Runaway Endangered Runaway Stranger Abduction Parent Abduction [disappearance]

Date Of Birth mm/dd/yyyy dob

Age age Years  or Monthsyrmo

Missing Since? (mm/dd/yyyy) date

Race Caucasion African American Hispanic Native American Other

Sex Male Female

Missing From (City) city
Missing From (State) state
Country country

Hair Blonde Brown Black Red hair

Eyes Brown Blue Green eyes

Height Feethtfeet Incheshtinches

Weight  wt lbs  kiloswttype

Wearing when last seen? (Describe the clothes worn when the missing child was last seen) wearing

Note 1 Any additional information, dealing with your child missing. Persons last seen with, towns where they your child might be, exc.?

note1

Note 2
note2

Police Department police
Police Ph. Number policeno
Case Number         caseno
Email Address        policeemail

2nd Contact (parent, P.I., NCMEC c2
2nd. Contact Ph. Number c2ph
2nd. Contacts Email          otheremail

Name of file that your picture is saved as. (xxxxxxxx.gif) picture