Missing Child Application

Nevada Child Seekers
Missing Child Report

Sonia Lucero, Case Manager

Sonia@nevadachildseekers.org

3230 E. Charleston Blvd Suite 118Las Vegas, NV 89104
Phone: (702) 458-7009
Fax: (702) 735-2812
 M
 F
 Yes/Si
 No
 Yes/Si
 No
 Yes/Si
 No
 
 Y
 N
 M
 F
 Y
 N
 M
 F
 Y
 N
 M
 F
 Y
 N
 M
 F
 Y
 N
 M
 F
 Yes/Si
 No
 Yes/Si
 No
 Was in the past/ Estuvo en el pasado
 Yes/Si
 No
 Yes/Si
 No
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Possibly/Probablemente
 Yes/Si
 No
 Yes/Si
 No
 Yes/Si
 No
 Yes/Si
 No
 
 Yes/Si
 No
 Yes/Si
 No
 Yes/Si
 No
 Yes/si
 No
 
 $30,000+
 Under/Debajo $30,000
 Under/Debajo $20,000
 Under/Debajo $10,000
Consent and Release Form/ Forma de consentimiento y la Liberación
I , custodial parent/ legal guardian,
Authorize Nevada Child Seekers and its authorized agents to assist in the search for .

My signature affixed hereto indicates my consent for the above agency to begin assistance and to continue to its natural end.

Consent is herby granted Nevada Child Seekers to use photographs of my child(ren) along with details concerning the disappearance and search for the child(ren). I understand and agree that Nevada Child Seekers is under no obligation to continue assisting in this search, if I have not given complete or accurate information or have failed to divulge all information within my knowledge or have failed to use my best efforts in this search. An unsupervised child is considered endangered and may be in need of medical attention.

I do hereby declare and warrant that I, the copyright owner of the photo of, have given permission and license to Nevada Child Seekers to submit for processing, reproducing and internet view of such photo on flyer. I hereby grant a nonexclusive license to Nevada Child Seekers to reproduce these photos for personal use only with the intent of its purpose, and I represent that I have a legal right to grant such a license.

By signing this agreement, I agree to release, indemnify, and hold harmless the above agency, its directors, officers, employees, volunteers, interpreters, partners and authorize agents from any and all liability, claims and causes of action which may result or arise from the release of details concerning the disappearance of the child(ren).

I understand that the registration of my child(ren) in no way guarantees the location of my child(ren). I agree to contact the above agency within 2 days of location of my child(ren), and I will not hold Nevada Child Seekers or its agents liable for the dissemination of the photographs, or responsible for showing the photographs for the period of the location/recovery, understanding some methods of dissemination will not be able to be removed such as Facebook and You Tube.

Nevada Child Seekers does not discriminate in any and all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program.

Signature: Date:

Print Name/Firma: Date/Fecha:

Relationship to child/ La relación al niño(a):

  • Sign Up For Our Newsletter