2. Office of Children and Youth
4. Records Request for Self or Minor Child

   Please allow 30 business days to process the request.

6. Date of Request*
   Date of Request
8. Your Name*
10. Your relationship to the case*
12. Case Name and Number*
14. Names/DOB of Child(ren) Involved*
16. Your email address/mailing address to send the records*
18. Your phone number*
20. Electronic Signature*

    1. By clicking this checkbox I agree that I am the person entered in the "Your Name" field above and to be used as my electronic signature. Enter your initials to confirm as your electronic signature
22. Your Initials*
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field