FAMILY INTAKE

DISCLAIMER

Disclaimer Agreement: I Agree to the Disclaimer by submitting this form, and I agree to allow We Can Bring You Hope, Inc. to have all information pertaining to this case and I give my permission to share flyers, work with law enforcement, conduct searches, contact Media, and use all social media outlets. I agree to allow We Can Bring You Hope to use any photos I have provided. I fully understand and agree to the photos being shared with the public and on the We Can Bring You Hope websites. In addition, I fully agree, that I will hold We Can Bring You Hope harmless of any liability, whether actual or perceived. I also state by submission of this form, that I am the legal guardian of the missing person, should this person be a minor. I understand that We Can Bring You Hope, Inc. is a Community Based Volunteer Organization that provides these services to families of the missing through contributions received, and I will not be billed for, nor asked for any money by We Can Bring You Hope, Inc, nor any of its representatives.. BY SUBMITTING I AGREE. I understand that I may not alter POSTERS OR FLYERS or use my own phone number or email while I am COORDINATING SERVICES with WCBYH. Using personal numbers and email may put Missing and or others at risk and has been explained to me, by submitting this disclaimer I agree to these terms in full and hold WCBYH Harmless of any liability.

FAMILY INTAKE ALL FIELDS MUST BE ANSWERED

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Full LEGAL Name of Person Completing this Form *

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Last

Your Relationship to Missing Person *

Your Address *

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City

State

Zip Code

Country

Your BEST Phone Number with which to contact you *

Please answer these questions to the best of your ability.

Is there any other time that the Missing person was Missing? Please list any time and Any other information that may assist us we need all the information that may help us. We are here to HELP you. Any thing no matter how small may be IMPORTANT we ar not here to JUDGE YOU or them. and we are not here to hurt you or them just get them SAFE. that is our concern. WE are not he LAW!
IF YOU FEEL THAT YOU NEED TO TELL US SOMETHING IN CONFIDENCE YOU CAN SEND US A PRIVATE MESSAGE OR CALL US AT 888-5-HOPE-02 24/7
We understand that this is a difficult time and that through the course of this event things may change.
We are here 24/7 to answer your questions, concerns or any challenges that may arise.
We can and will make adjustments to any materials created so that the most accurate and updated information is out in circulation for your Missing Loved One.

Your Email *

Full LEGAL Name of Missing *

First

Last

ANY ALIAS OR NICK NAMES OR FORMER NAMES AND THE ADDRESS OF THE MISSING PERSON *

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City

State

Zip Code

Country

Missing Persons Social Media: FACEBOOK, SNAPCHAT, EMAIL ADDRESS (ANY KIND OF SOCIAL MEDIA LIST THEM ALL THAT YOU CAN THINK OF) *

Phone Number for Missing description of phone and name of carrier *

City, State and County of where Missing Person went Missing from *

Date Last Seen & By Whom and a description of what they were wearing IF KNOWN *

Date of Birth of Missing and Place of birth *

Age at the time they went MISSING and age now *

Police Department Name *

Police Department Phone Number *

Case Number *

Any known circumstances concerning their disappearance *

BIO MOTHERS AND FATHER'S NAME CONTACT INFORMATION *

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Last

SPOUSE OR SIGNIFICANT OTHER NAME AND CONTACT INFORMATION *

MISSING PERSONS CLOSEST FRIENDS with contact information *

SIBLING NAMES AND CONTACT INFORMATION FOR LIVING SIBLINGS *

please list any other pertinent information that you think maybe helpful that has not been asked on this form. *

WAS THE MISSING IN AN ABUSIVE RELATIONSHIP? IN FEAR FOR THEIR LIFE? HAVE ANY RECENT MAJOR LIFE CHANGES? PLEASE LIST. *

Height *

Weight *

Eye Color *

Hair Color/ Description *

Contacts or Glasses or Dentures and description of them *

Did the Missing person have any Tattoos, Scars, and Birthmarks, Surgeries that required any implants such as pins, rods, etc. specific distinctive features PLEASE DESCRIBE *

List their Dentist Name, address and Phone number if known. Dental Issues (Dentures, Braces, Teeth color, Etc.) *

IS THERE A HISTORY OF DRUG ADDICTION *

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Last

List their Medical Provider Name, Address and Phone Number if Known. Medical concerns and Are they on any Medications? If known Please list *

DOES THE MISSING PERSON HAVE A HISTORY OF MISSING OR IS THIS THE FIRST TIME? IF SO HOW OFTEN DOES THIS HAPPEN *

How did you hear about us? *

CHECK THE BOX TO AGREE *

I Agree to the Disclaimer Listed Above. I certify that I am the legal Guardian IF this is a MINOR that I am reporting.

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