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CRC/Ohana Runaway
Name:
(Required)
Last, First MI
Date of Birth:
(Required)
Sex:
(Required)
Male
Female
Race:
(Required)
Asian
Black
Native American/Indian
Unknown
White
Height:
(Required)
Feet ‘ Inches (ex. 5’04)
Weight:
(Required)
Pounds
Eye Color:
(Required)
Black
Blue
Brown
Green
Gray
Hazel
Unknown
Hair Color:
(Required)
Black
Blonde
Brown
Gray
White
Blue
Green
Orange
Purple
Pink
Red
Bald
Unknown
Scars, Marks, Tattoos:
Clothing Description:
Date of Last Contact:
(Required)
MM slash DD slash YYYY
Suicidal at Last Contact?
Yes
No
Unknown
Mental Illness, Disabilities, Medical Conditions:
Comments/Addtl Information:
Legal Guardian/Employee Contact:
(Required)
Phone Number:
Today's Date:
MM slash DD slash YYYY