Date whereabouts became unknown (month, day, year
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(last name, first name, middle initial
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Name / description of each caretaker believed to have physical custody of child
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_1C.doc
State of Kansas Department for Children and Families Prevention and Protection Services CHILD ABUSE AND NEGLECT PROTECTIVE SERVICE ALERT REPORT Appendix 1C Rev. Oct. 17 Page 1 of 2
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_1C.pdf