Missing/Abducted Child On-Line Notification Form

Please Read Carefully: 
*This form is intended to provide VCA with information about a missing child and enable them to begin the preliminary steps for "registering" the child.
*Filling out this form does not formally "register" a missing child with VCA.
*Before VCA can begin poster dissemination and other location activities your case must be assigned "registered" status.
*VCA will not register a case until it receives the completed registration forms and other required documentation.
*After you have successfully completed and submitted this form, a confirmation page will be displayed.  This page will contain links to the other forms you should print out and fax to VCA.

Reporter Information
(Required information fields are marked with an *)

*Full Name: 
*Address:
*City:
*State:
*Zip Code:
County:
*Daytime Phone:
*Evening Phone:
*Relation to Child:
E-Mail Address: 

Incident Information

*Date child became missing/abducted:
Type of Incident:
*The child became missing (city & state) from:

*Provide a brief explanation of the incident:
Provide any information on the possible destination of child:

*Was incident reported to law enforcement?  Yes     No  
 Date Reported:
*Law enforcement agency name:   
*City:
*State:
*Phone Number:   
*Law Enforcement Agency Case #:
NCIC #:
Investigating Officer's Name:

 

Missing/Abducted Child # 1 Information

*First Name: 
Middle Name:
*Last Name:  
Nicknames:
*Date of Birth:
Social Security Number:
Height:
Weight:
Sex:
*Race:
*Eye Color: 
*Hair Color:
Hair Style:

*Provide description of clothing that child was last known to be wearing:
Check all that apply:

Glasses: Contacts:  Braces: Right-handed: Left-handed:

Scars/Marks:    
Describe any scars and/or marks that the child may have and its location on body, if applicable (i.e., surgical scars, injury scars, birthmarks, etc.):

 Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

 Describe any medical or mental condition that the child may have:

 

  • If there are additional children that are missing/abducted, continue filling out the form providing the additional information

  • If there are no other children to report, click the submit button

Missing/Abducted Child # 2 Information

*First Name: 
Middle Name:
*Last Name:  
Nicknames:
*Date of Birth:
Social Security Number:
Height:
Weight:
Sex:
*Race:
*Eye Color: 
*Hair Color:
Hair Style:

*Provide description of clothing that child was last known to be wearing:
Check all that apply:

Glasses: Contacts:  Braces: Right-handed: Left-handed:

Scars/Marks:    
Describe any scars and/or marks that the child may have and its location on body, if applicable (i.e., surgical scars, injury scars, birthmarks, etc.):

 Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

 Describe any medical or mental condition that the child may have:

 

  • If there are additional children that are missing/abducted, continue filling out the form providing the additional information

  • If there are no other children to report, click the submit button

Missing/Abducted Child # 3 Information

*First Name: 
Middle Name:
*Last Name:  
Nicknames:
*Date of Birth:
Social Security Number:
Height:
Weight:
Sex:
*Race:
*Eye Color: 
*Hair Color:
Hair Style:

*Provide description of clothing that child was last known to be wearing:
Check all that apply:

Glasses: Contacts:  Braces: Right-handed: Left-handed:

Scars/Marks:    
Describe any scars and/or marks that the child may have and its location on body, if applicable (i.e., surgical scars, injury scars, birthmarks, etc.):

 Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

 Describe any medical or mental condition that the child may have:

 

If you wish to return to the top of the form and review/edit the information you have entered, click here.