What The Request For Assistance Form Looks Like

NOTE: This form does not work. It is provided for you to look over, so that you can locate and gather the information.

If you want to submit an actual form, you must click here.

But be sure you have read this page first.

 

SAMPLE   FORM

This form is concerning a missing individual. Please explain how the person went missing. 
In other words, is the missing one an old friend who you lost touch with over the years? Is it an abducted child? Is it a child lost in the woods? Is it an elderly person who wandered away from home? A teenager who was unhappy or on drugs and ran away? A well adjusted teenager in a happy home who just never came home from school? An unhappy spouse who never came home from work? Please be honest - with us, and with yourself - here.


required


This beginning information is about you...
It is how we can get helpful information to you. Confidentiality is GUARANTEED!

  1. Your Name: 
    required

  2. Your e-mail address: 
    required
    (Don't forget to check your email - you should receive an initial reply within 72 hours.)
      

  3. Your telephone number including area code and country code:
    required
    (We ask for this in case we receive urgent & time sensitive information. Otherwise, no one will ever call you, and confidentiality is GUARANTEED)

  4. Your Relationship to the missing?
    required   

    All information below is concerning the missing person:
    NOTE: You may think some of the information requested below will be hard to locate - almost all of it will be contained in the police report. Just ask them for a copy.

  5. The missing person's complete name:
    required
     

  6. Missing person's gender at birth.
    required

  7. Missing person's gender at time of going missing.
    required
      

  8. The missing person's race and ethnicity:

      

  9. The missing person's weight:

      

  10. The missing person's height:

      

  11. The missing person's eye color:

      

  12. the missing person's hair color:

      

  13. Scars, birth marks or outstanding features on the missing person: 

      

  14. Does the missing person have any allergies, illnesses or handicaps?

       

  15. The missing person's date of birth:
    Example: September 11, 1999
    required
      

  16. The missing person's place of birth:

      

  17. The missing person's time of birth (from birth certificate):

      

  18. The date the person became missing:
    Example: September 11, 1999

      

  19. Exact time person was discovered missing:

    If exact time is not applicable, give the range of time -
    Example: between 4:15 and 6:30pm} and explain circumstances in box 26.

  20. Missing person's home address at the time of disappearance: 

      

  21. Location and address where the missing person was last seen:
    Example: Meadow High School, 123 First St. Bronx City, New Jersey 89109 USA

      

  22. Describe the clothing of the missing person, as best as possible,  at the time of disappearance: 

      

  23. Exact time of 911 police call:

    If no 911 call was made, please explain why in box 26.
      

  24. Who made the 911 call:

      

  25. The callers relationship to the missing person:

         

  26. Circumstances... as many important details as you can remember -- (The more information you can provide here, the more we may be able to help you. Also please include any other additional information that may help.)

THIS IS A SAMPLE FORM ONLY - BUTTONS DO NOT WORK


A Chance Connection
9309 SCENIC MOUNTAIN LN
LAS VEGAS NV  89117

Phone: 702-645-2601


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