Print Form to Register A Case

Child Protection Education
of America, Inc.
Advocate for America's Missing Children
410 Ware Blvd. Suite 710, Brandon, FL 33511
866-USA-CHILD
813-626-3001

Data Information Report

Instructions when filling out this form

Please mail this completed form to Child Protection Education of America, Inc. at the address above.

Include a recent photograph of the missing child. The photograph needs to be 5 x 7 or smaller. (4x6 or 3x5 is better) Also, color photographs show much more detail and reproduce better for posters and the Internet. Color photographs catch the eye of a viewer much more than a black and white. Do not send a photocopied photograph or fax us a photograph. We can not use them.

3. If this case is a parental abduction, we must have a copy of your current custody papers.

All children registered with the Center must be entered into the National Crime Information Computer (NCIC) by law enforcement. (NOTE: Ensure the spelling of the name and the date of birth of the child is entered correctly.)
If your child returns without our knowledge, it is very important that you contact (Caseworker name) at 866-USA-CHILD immediately. Your child's case number is (Case #) .

Date:_____________________

Report Type: Circle One

Runaway ......Parental Abduction......Criminal Abduction.....Missing.....Unidentified....Abandoned

Name of Reporting Parent: ___________________________________________

Address: ___________________________________________

City:__________________ State:_____________ Zip Code: _____________

Home Phone:__________________ Business Phone:________________________

Information on Missing Child (please print)

Last Name:__________________ First Name:_________________ M.I.:______

A.K.A. and/or Nick Name:___________________________________________

Date of Birth:_____________ Current Age:_____________

Date Missing:_____________ Missing From: ______________________

Sex: (Circle one) M or F Height:__________________ Weight:__________

Race (circle one) White.....Black.....Hispanic.....American Indian.....Oriental.....Bi-Racial.....Other

If other describe:______________________________________________________

Complexion (circle one) Light.....Medium.....Dark

Hair Color (circle one) Brown.....Blond.....Black.....Auburn.....Red.....Gray.....Other:_________

Hair Description (circle one) Curly.....Wavy.....Straight.....Length_______________________

Eye Color (circle one) Brown.....Blue.....Green.....Hazel.....Other_______________________

Eyeglasses - Yes or No .....If yes, please describe____________________________________

Contact Lenses - Yes or No ...If yes, please describe_________________________________

Passport Numbers: Father ______________________

Mother________________________

Guardian______________________

Child_________________________

Military ID Number (Child) _________________________________

Last School Attended

Name:___________________________________________________

Address:_________________________________________________

City:__________________ State:______ Zip Code:________ Phone:_______________

Identifying Marks of the Missing Child (i.e. tattoo's, piercing, birthmarks, speaking problems, etc.)

________________________________________________________________________

Clothes , describe when last seen

________________________________________________________________________

Description of Abducting Parent/Person:

Last Name:_____________________ First Name: ___________________ M.I.: _______

Address: _________________________________________________

City: ______________________ State: _____________ Zip Code: _________________

Date or Birth : _______________

Hair Color: _________________ Description: __________________

Eye Color: _________________ Glasses: Yes or No

Complexion: ________________ Height: ___________ Weight: ___________________

Identifying Marks:

________________________________________________________________________

Previous Employer of Abductor: ________________________________________________________________________

Address, City, ST, Zip: ________________________________________________________________________

Phone Number: _______________________________

Auto ID Number: _____________________________

License Number: ______________________________

Warrant Number: _____________________ Type of Warrant: _____________________

Issued By: ______________________ Where:____________________ Date:__________

Law Enforcement Agency:

Name of Agency: ________________________________________________________

Address : _______________________________________________________________

City: ____________________ State: __________ Zip Code: ______________________

Phone Number: _________________ Officer in Charge: __________________________

Child's Case Number: ________________ NCIC Number: ________________________

Details of Disappearance:

________________________________________________________________________

I/We certify, to the best of my/our knowledge that the above information is correct as shown. I/We give Child Protection Education of America (CPEA) my/our consent to release photographs and other pertinent information of my/our missing child to the public. I understand that this will be done through various means including newspapers, magazines, flyers, television, and other avenues. I/We understand that CPEA does not take the responsibility for returning my/our child to the parent. I/We agree to fully release CPEA from any liability, which may result from the actions of the CPEA in the search of my/our child. I/We agree to notify CPEA upon location of my/our child.

____________________________________Date_______

Signature of Parent, Guardian or Law Enforcement Official

____________________________________Date_______

Signatures of Parent, Guardian or Law Enforcement Official

If registering a runaway or missing juvenile case, click here for more information.

If registering a parental abduction, you can find more information here.