Report of Suspected/Alleged Child Abuse or Neglect

Department of Child Services (DCS) Reporting Number 1-800-800-5556

 
 
 
 
 
 
 
 
 
 
 
 

 

Mother/Guardian

 

Last, First

 

Mother/Guardian street address if different from child's

 

Mother/Guardian city, state zip code if different from child's

 

Mother/Guardian Phone

Phone number including area code (###-###-####)

 
 
 
 
 
 

 

Father/Guardian

 

Last, First

 

Father/Guardian street address if different from child's

 
 

Father/Guardian Phone

Phone number including area code (###-###-####)

 
 
 
 
 
 

Please list the other children in the home including their age, date of birth and sex.