Delaware Child Protective Registry PDF Details

In the realm of safeguarding children and ensuring a nurturing environment for them, the Delaware Child Protective Registry Consents Form emerges as a crucial document. This form serves as a bridge, allowing specific details from the Delaware Child Protection Registry to be shared with authorized entities, ensuring that individuals working with or around children do not have a history of child abuse or neglect. The procedure to complete and submit this form is straightforward, requiring it to be faxed or emailed to the Division of Professional Regulation, adhering to the specific contact information provided. The form spans several sections, demanding information about the applicant that includes basic identification details, any other names used, social security number, date of birth, gender, race, and ethnicity, alongside the residential address. Crucially, it poses a question regarding the individual's presence on the Delaware Child Protection Registry for any substantiated cases of abuse or neglect, requiring a candid disclosure and an explanation if the answer is affirmative. The document emphasizes the applicant's consent, allowing the Delaware Department of Services for Children, Youth and Their Families to disclose any substantiated cases of child abuse or neglect involving the applicant to the requester. It encapsulates the assurance of confidentiality and the legal release of liability for the Delaware Department of Services for Children, Youth, and Their Families, underscoring the delicate balance between privacy and protection. Completing this form within 90 days from the date of signature is imperative for the request to be processed, emphasizing the time-sensitive nature of such assessments in child welfare endeavors.

QuestionAnswer
Form NameDelaware Child Protective Registry
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschild protection registry, delaware child abuse clearance, delaware child abuse registry, child abuse registry in delaware

Form Preview Example

DELAWARE CHILD PROTECTION REGISTRY CONSENT FORM

Web Portal

Instructions

Complete the below form and fax or email directly to the Division of Professional Regulation at the contact information below:

Fax: (302) 739-2711

DE Application Number: APP-__________________

Email: customerservice.dpr@delaware.gov

 

Request must be within 90 days of signature date in order to be processed

PART I - APPLICANT INFORMATION

Name (Last*, First*, Middle): *___________________________, *_________________________, __________________

Other Name(s) used:

None ________________________________________________________________________

Social Security #: ________ - ________ - ___________

Date of Birth (mm/dd/yyyy)*: _____ - _____ - _______

Gender*:

Male

Female

Race: ______________________________________

Ethnicity: Hispanic

Non-Hispanic

Address (Street, City, State, Zip): ______________________________________ _______________ _____ __________

Are you on the Delaware Child Protection Registry for any substantiated cases of child abuse/neglect?

Yes

No

If yes, explain:_____________________________________________________________________________________

I hereby authorize The Delaware Department of Services for Children, Youth and Their Families to provide the below named requester with all substantiated cases of child abuse or neglect concerning me that are active on the Delaware Child Protection Registry. I further release the Delaware Department of Services for Children, Youth and Their Families, its officers and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.

Signature: ____________________________________________

Date: __________________

Parent/Guardian Signature (If applicant is under the age of 18): ______________________________________________

PART II - REQUESTER INFORMATION

Check one option below and complete required information*:

1. Agency Request – Agency Name*: DIVISION OF PROFESSIONAL REGULATION

2. Individual Request - Self

*Mandatory

Revised 6/2020

How to Edit Delaware Child Protective Registry Online for Free

The delaware child protection registry consent form completing course of action is hassle-free. Our editor enables you to use any PDF file.

Step 1: Initially, choose the orange button "Get Form Now".

Step 2: After you've entered the delaware child protection registry consent form editing page you can see all of the options you may perform relating to your file at the upper menu.

Complete the delaware child protection registry consent form PDF and provide the content for every single segment:

portion of fields in delaware child abuse clearance

Write the required details in the Are you on the Delaware Child, Yes, If yes explain, I hereby authorize The Delaware, Signature, Date, ParentGuardian Signature If, PART II REQUESTER INFORMATION, Check one option below and, Agency Request Agency Name, and Individual Request Self part.

Completing delaware child abuse clearance stage 2

Step 3: Select the button "Done". Your PDF file may be transferred. You will be able obtain it to your pc or email it.

Step 4: To protect yourself from any type of problems in the future, try to get around two or three duplicates of the document.

Watch Delaware Child Protective Registry Video Instruction

Delaware Child Protective Registry isn’t the one you’re looking for?

Related Documents

  • Delaware Form Ap1

    "... Form ap State of Delaware Department of Finance Report of Unclaimed Division of Revenue or Abandoned Property Box 8931 Wilmington De 19899 Verification for Report Year 20 Information Please enter one media. Federal company address, ..."

  • Declaration Guarantor Form

    "... aboriginal affairs and affaires auto ch tone set page of northern development canada veloppement du nord canada protected secure certificate of indian status sc is statutory declaration in lieu of guarantor privacy act statement personal information provided in this document is collected by aboriginal affairs and northern development canada and under the authority of the indian act individuals have the right to the protection of and access to their personal information under the privacy act the information provided is voluntary failure to provide sufficient information may render the application invalid or may result in processing delays information provided is subject to routine verification including verification against the indian register and may for the purpose of receiving applications collect personal information from indian registry administrators furthermore personal information will be disclosed to third party for the purpose of printing the sc is in the performance of these duties personal information will be processed and used in accordance with the provisions of the privacy act further details on the collection use and disclosure of personal information are described under the personal information bank in app 110 which is detailed at www info source gcc notice to all applicants the sc is remains at all times the property of the government of canada and must only be used by the person in whose name it is issued any false or misleading statements on this form or relating to any document in support of this application including concealment of any material fact selling an ..."

  • Delaware Corporation Dissolution Form

    "... delaware division of corporations 401 federal street suite dover de 19901 ph 302 739 3073 fax 302 739 3812 certificate of dissolution short form dear sir or madam attached please find form for certificate of ..."

  • Delaware Form 1089

    "... dela war form 1089 date of order re ques for blank delaware income tax forms name address city state zip code enter after each the quantity nee ded des cri pt ions on back of ..."

Please rate Delaware Child Protective Registry

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .