VS-37-DCBS-YOUTH 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Full Legal Name of Registrant' in the designated fields. Ensure you enter the first, middle, and last names accurately.
3. If applicable, provide the original birth name of the child in the second field. This is crucial for adopted children.
4. Enter the 'Date of Birth' by selecting the month, day, and year from the dropdown menus.
5. Complete the 'Place of Birth' section by entering the Kentucky city or town and county where the child was born.
6. Fill in details for both parents, including their full names and mother's maiden name.
7. Provide your contact information as a DCBS-PCC case worker or representative, including phone number and email address.
8. Type your name in field 12 for an electronic signature. Click on the checkbox to acknowledge your electronic signature, which will auto-populate today's date.
9. Review all entered information for accuracy before clicking on 'Email Completed Form' to submit your request.

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