Weld County Child Protection Referral Form

If this report needs immediate attention, please call 911

If you wish to talk to a person immediately, please call HOTLINE 1-844 CO-4-KIDS / 1-844-264-5437

Please read carefully and take time to fill out this form according to your knowledge.

Type in N/A if information is unavailable or if you wish to remain anonymous.

Reporting Party (this information is confidential)

Dec 22, 2024

First name (Required)

Last name (Required)

Address (Required)

City (Required)

State (Required)

Zip (Required)

Primary Phone (Required)

Secondary Phone

Agency (Required)

Position (Required)

Additional Information

Mandatory Reporter Relationship to Child (Required)