Report Suspected Child Abuse or Neglect

To the extent of your knowledge, please provide the following information about the child.
 
Sex:
To the extent of your knowledge, please provide the following information about the suspected abuser.
 
If you answered "Yes" to the question above, please provide information about the child's parent or other person responsible for the child's care.
 
Please describe the abuse or neglect to the child.
 
To the extent you are aware, please supply the following information about the child's household.
 
Have you contacted Child Protective Services or your local police department about your concerns?
If you answered "Yes," to the question directly above, please answer the following six questions.
 
Do you have information regarding the child’s parent or other care-giver?
 
Print this page before clicking the “Submit” button below, if you would like a hard copy of your report.