Child Maltreatment Reporting Form

Date of Report: 11/30/2020

If you feel this child(ren) is in immediate danger, please call 911. If you are unsure and/or would prefer to speak to a Child Protection social worker, please call Anoka County Child Protection at 763-324-1440 and a social worker will assist you with your report.


Child

Please provide as much information about the child as possible


Other Child NameDOB/AgeGenderSchool/Daycare 

Parent

Please provide as much information about the parent as possible


Alleged Perpetrator

Please provide as much information about the alleged perpetrator as possible

Reporter

Please provide as much information about the reporter as possible





Reason For Report

*

Attach Files

Please attach any pictures (jpeg), pdf, or other documents to support the report



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