Bad Date Report

Please complete the form below.

Community Partner Information

Submitter Information (Optional)

Name
YYYY slash MM slash DD

Incident

Time of Incident(Required)
:
YYYY slash MM slash DD
PIcked Up By(Required)

How Was Date Arranged(Required)
Do you want to report this to the police?(Required)
Would you like this to appear as public alert?(Required)

Description of Vehicle

Number of Doors
Condition
Make/Model
Type

Description of Suspect

Suspect Name