Missing Child Application
Nevada Child Seekers is a non-profit that assists families of missing children. We are not law enforcement and do not have access to your police reports. Please have your report on hand before filling out this application as many of the information needed will be on the event report you filed with law enforcement. 702-458-7009
Email address *
Parent/Guardian Full Name *
Phone Number *
Address *
Email *
Police Dept. Event Number *
Full Name of Child *
Date Missing *
Age *
Sex *
Race *
Height *
Weight *
Eye Color *
Unique Characteristics (Tattoos, braces, scars, etc) *
Last Seen Wearing *
Did Child Take Anything With Them? *
Major Cross Streets Where Child Was Last Seen? *
What are the circumstances of your case, how did the child go missing, etc? *
E-Signature Required
By filling out the below missing child application you authorize consent for the our agency to begin a public search for said missing child(ren) and to continue assistance with the search to its natural end. Consent is hereby granted to Nevada Child Seekers to use photographs of my child(ren) along with the details concerning the disappearance and search for the child(ren). I understand and agree that Nevada Child Seekers is under no obligation to continue assisting in this search, if I have not given complete or accurate information or have failed to divulge all information within my knowledge or have failed to use my best efforts in this search. I do hereby declare and warrant that I the copyright owner of the child(ren) photos, have given permission and license to Nevada Child Seekers to submit for processing and reproducing and internet view of such photo on flyer and e-flyer systems. I understand that the search and efforts of the agency for the child(ren) in no way guarantees the location of my child(ren). I agree to contact the above agency within two days of location of my child(ren), and I will not hold Nevada Child Seekers or its agents liable for the dissemination of the photographs or responsible for showing the photographs for the period of the location/recovery, understanding some methods of dissemination will not be able to be removed such as social media. Nevada Child Seekers does not discriminate in any and all of its programs and activities in the basis of race, color, national origin, age, disability, ability, and where applicable, sex, marital status, familial status, parental status, region, sexual orientation, genetic information, political beliefs, reprisal, or because of all or part of an individual’s income is diverted from any public assistance programs.
Please Type Your Full Name
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service