Intake Form

Intake Form

Welcome to Dear Casi. We understand this is a difficult time, and we're here to help. This form gathers essential information to assist in the search for your missing loved one.
Why Your Information Matters: Detailed information helps us tailor our support and coordinate with relevant agencies. Every piece of information can make a significant difference.

How We Use Your Information:
- Create awareness campaigns
- Coordinate with law enforcement
- Develop personalized webpages
- Engage the community
- Connect with media outlets
Your Privacy and Security: Your information is confidential and will only be shared with authorized parties involved in the search efforts.

Getting Started: Please fill out the form accurately and thoroughly. If you need assistance, reach out to us. Together, we can turn hope into action and ensure no one is left searching alone.
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Phone Number
Missing Person Details
Missing Person Information:

First NameMiddle NameLast Name
Date Of Birth:

MonthDayYear
Date
Date Missing:

MonthDayYear
Date
Your Relationship:
Last Known Location:
Other Relationship Status:
Circumstances of Disappearance:
Last Known Clothing:
Physical Description
Height:
Weight:
Hair Color:
Eye Color:
Distinguishing Features:

TattoosPiercingsScarsMarkingsOther
Description of Distinguishing Features:
Anything Else We Should Know:

Mental illnessSubstance abuseKnown to leave homeHad made mention of self-harmOther
Photos:

Cancelof
Case Information
Has there been a missing persons report filed?

YesNo
Who is the handling agency?
Investigator's Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you the custodian of the case?

YesNo
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Do you have a flyer?

YesNo
In what ways have you been able to put out the word for your missing loved one?

Law Enforcement/CrimestoppersLocal News Outlets and PlatformsSocial MediaShelters/MissionsBillboardsFlyer DistributionQR CodesLinktreeMerchandise: T-shirts, Magnets, etc.Podcasts or Radio ShowsPolitical leadersNAMUSThe Doe NetworkThe Charley Project - for missing persons who have been missing more than a yearOther
Do you currently have any other organizations assisting?

YesNo
Other Organization's Name?
Contact Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Other Organization's Name?
Contact Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Other Organization's Name?
Contact Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Other Organization's Name?
Contact Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Services You Would Like Help With:

Search and Rescue CoordinationCreating Awareness CampaignsSocial MediaFundraising SupportCreating Personalized WebpageCommunity OutreachPrivate InvestigatorLinktreeMerchandise: T-shirts, Magnets, etc.Podcasts or Radio ShowsPolitical leadersNAMUSThe Doe NetworkThe Charley Project - for missing persons who have been missing more than a yearOther
Dear Casi Data Sharing Terms and Conditions

1. Introduction: By providing your information to Dear Casi, you agree to the following terms and conditions regarding the sharing and use of your data. These terms are designed to ensure the privacy and security of your information while enabling us to assist in the search for your missing loved one.

2. Data Collection and Use Purpose: The information you provide will be used solely for the purpose of assisting in the search for your missing loved one. This includes creating awareness campaigns, coordinating with relevant agencies, and providing support services. Types of Data: The data collected may include personal information, contact details, information about the missing person, and any other relevant details you provide.

3. Data Sharing Authorized Parties: Your information may be shared with authorized parties, including law enforcement agencies, search and rescue organizations, media outlets, and other relevant entities involved in the search efforts. Consent: By agreeing to these terms, you consent to the sharing of your data with the aforementioned parties to facilitate the search for your missing loved one.

4. Confidentiality and Security Confidentiality: Dear Casi is committed to maintaining the confidentiality of your information. We will take all reasonable measures to protect your data from unauthorized access, disclosure, or misuse. Security Measures: We implement appropriate technical and organizational measures to ensure the security of your data, including encryption, access controls, and secure storage.

5. Data Retention Retention Period: Your data will be retained for as long as necessary to fulfill the purposes outlined in these terms. Once the search efforts are concluded, your data will be securely deleted or anonymized, unless you request otherwise. Updates and Corrections: You have the right to request updates or corrections to your data at any time. Please contact us to make any changes.

6. Your Rights Access: You have the right to access the information we hold about you and your missing loved one. Withdrawal of Consent: You may withdraw your consent to the sharing of your data at any time. However, this may impact our ability to assist in the search efforts. Complaints: If you have any concerns about the handling of your data, please contact us. We will address your concerns promptly and take appropriate action.

7. Amendments: Dear Casi reserves the right to amend these terms and conditions at any time. You will be notified of any changes, and your continued provision of information will constitute acceptance of the updated terms.

8. Acceptance: By signing below, you acknowledge that you have read, understood, and agree to abide by these terms and conditions
Full Name
By entering your name, you acknowledge that this action constitutes your electronic signature.
Date

MonthDayYear
Date
Should be Empty:

Intake Form

Missing Person Details

Physical Description

Case Information