12. Appendices

12.11. Appendix K: Guardian Registration Form

To collect essential information from guardians to support family reunification efforts during a response.

Parent or Legal Guardian Information
Primary Parent/Guardian Name:
Primary Contact Number: Type: ☐ Mobile ☐ Home ☐ Work
Secondary Parent/Guardian Name:
Secondary Contact Number: Type: ☐ Mobile ☐ Home ☐ Work
Child Information
Child’s Name (Last, First, Middle): DOB: ____________________ ☐ Unknown
Primary Address: Age: __________ Mo / Yrs. (circle one)
Primary Language: ☐ English ☐ Spanish ☐ Other _____________________ ☐ Non-verbal
Gender ☐ Female ☐ Male ☐ Other
Eye Color ☐ Brown ☐ Blue ☐ Green ☐ Gray ☐ Multiple ☐ Other _____________________
Hair Color ☐ Brown ☐ Blonde ☐ Black ☐ Red ☐ Other _____________________
Identifying Features:

☐ Scars
☐ Moles
☐ Birthmarks
☐ Tattoos
☐ Braces
☐ Missing Teeth
☐ Glasses
☐ Other:		 Items worn by or with child:

☐ Pants/Shorts
☐ Shirt
☐ Dress/Skirt
☐ Shoes/Socks
☐ Coat/Jacket
☐ Jewelry
☐ Medical Devices
☐ Other:
Identifying Features Description: Items Worn by or with Child Description:
Siblings: ☐ None ☐ 1 ☐ 2 ☐ 3 ☐ 4+ ☐ Unknown Sibling’s Name(s):
School Grade: ☐ N/A ☐ Pre-K ☐ Kindergarten ☐ 1st ☐ 2nd ☐ 3rd ☐ 4th ☐ 5th ☐ 6th
☐ 7th ☐ 8th ☐ 9th ☐ 10th ☐ 11th ☐ 12th ☐ Unknown
School Name: Teacher’s Name:
Pet(s): ☐ None ☐ Dog ☐ Cat ☐ Other ___________
☐ Unknown		 Pet Names:

Completed by FRC Staff

Review Status
Status:

☐ Parent/Guardian Submission Staff Reviewer: ___________________________ Time: ________________
☐ In Review Staff Reviewer: ___________________________ Time: ________________
☐ Complete Staff Reviewer: ___________________________ Time: ________________
Additional Details:

A downloadable version of this appendix is available here.