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The Department of Child and Family Services is committed to the protection of children under the age of 18. All cases involving incidences of child porn or sex exploitation of children in Bermuda are investigated by Family Services and the Bermuda Police Service. To make a report directly to the Department of Child and Family Services please complete this form.

Fields marked with a star * are mandatory.

Child's Details:
* First Name:
Last Name:
Date of Birth:
Street Address:
Parish:
School:

Mother's Details:
First Name:
Last Name:
Street Address:
Parish:
Telephone:	(w)
	(h)

Father's Details:
First Name:
Last Name:
Street Address:
Parish:
Telephone:	(w)
	(h)

Guardian's Details:
First Name:
Last Name:
Street Address:
Parish:
Telephone:	(w)
	(h)

Siblings:
1. Name:
Age:
2. Name:
Age:
3. Name:
Age:
4. Name:
Age:

Reason for Referral: (Please check the area(s) that apply and give a written account of your observations. Indicate the nature & extent of injuries, behavioral indicators, frequency etc...)
Physical Abuse	Behaviour Problem
Neglect	Emotional Abuse
Other
Reporter's Narrative:

Child's Disclosure (if any):

Past Concerns (if any):


Click below to submit your complaint.