If you believe your life has been threatened then yes, your first stop is a police station to make a report and get advice. They may well direct you to a shelter. In either case, you can find a way to contact them here: http://willicklawgroup.com/domestic-violence/.
Once you are safe, then consider contacting a lawyer as to whatever has happened regarding your parental rights. There really is no such "form." At the same website, on the "Termination of Parental Rights" page, you can see a great deal of background information that may be of use to you, but it is hard to see just what happened or why from your question, and you really should consult with a qualified family law specialist as to your specific facts and circumstances -- AFTER you talk to the police and get to a point of personal safety.
Answered on Sep 11th, 2014 at 6:09 PM